Individual
JOHN LACY STURDIVANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
920 DOUG WHITE DR STE 510, MYRTLE BEACH, SC 29572-4183
(843) 497-7772
(843) 848-7530
Mailing address
920 DOUG WHITE DR STE 510, MYRTLE BEACH, SC 29572-4183
(843) 497-7772
(843) 848-7530
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
22001
SC
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
22001
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220013
—
SC
Enumeration date
08/29/2006
Last updated
01/25/2022
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