Michael Douglas Mavis

Key facts

NPI

1053809095

Entity type

Individual (NPI type 1)

Primary specialty

Contractor 171W00000X

Practice address

233 Mountain Estates Rd
Pickens, SC 29671-8518

Phone

(864) 637-8770

NPI assigned

Apr 25, 2018

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 25, 2018.

{
    "created_epoch": "1524614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524614400000",
    "number": "1053809095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 MOUNTAIN ESTATES RD",
            "city": "PICKENS",
            "state": "SC",
            "postal_code": "296718518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 MOUNTAIN ESTATES RD",
            "city": "PICKENS",
            "state": "SC",
            "postal_code": "296718518",
            "telephone_number": "864-637-8770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAVIS",
        "first_name": "MICHAEL",
        "middle_name": "DOUGLAS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-25",
        "last_updated": "2018-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pickens, SC

• Byron Patterson Marsh, M.D.
• Daniel Martin
• Teresa Massey, BSN
• Sherri Frady Matkovich, LPES
• Matrix Rehabilitation South Carolina, Inc
• Dana M McCall, B.A.
• Cecilee Maelin McCloskey
• Kathy McGuffin, RN
• Sharon R McMahan
• Samuel G Medders, M.S.

All providers in Pickens, SC · Contractor in South Carolina