Active NPI
Cornell Caviness, PA C
- Family Medicine Physician
- Georgetown, SC
National Provider Identifier
1558413435
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- A342
- Practice address
- 1075 N Fraser St
Georgetown, SC 29440-2848 - Phone
- (843) 527-3588
- NPI assigned
- Jan 18, 2007
- Last updated
- Dec 29, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | A342 | SC | Primary |
Addresses
Primary practice location
1075 N Fraser St
Georgetown, SC 29440-2848
Mailing address
1075 N Fraser St
Georgetown, SC 29440-2848
Phone (843) 527-3588
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RHC168 | Medicaid | SC | |
| GP1371 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A342 | SC | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325116800000",
"number": "1558413435",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1075 N FRASER ST",
"city": "GEORGETOWN",
"state": "SC",
"postal_code": "294402848",
"telephone_number": "843-527-3588"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1075 N FRASER ST",
"city": "GEORGETOWN",
"state": "SC",
"postal_code": "294402848",
"telephone_number": "843-527-3588"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAVINESS",
"first_name": "CORNELL",
"credential": "PA C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-18",
"last_updated": "2011-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "SC",
"license": "A342",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "RHC168",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GP1371",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Georgetown, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.