Provider Demographics
NPI:1063694461
Name:COVINGTON, SAMUEL CLAYTON (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:CLAYTON
Last Name:COVINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1796 CHELWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3702
Mailing Address - Country:US
Mailing Address - Phone:843-412-0032
Mailing Address - Fax:
Practice Address - Street 1:1796 CHELWOOD CIR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3702
Practice Address - Country:US
Practice Address - Phone:843-412-0032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2010-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12655207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC126553Medicaid
SC126553Medicaid
SC1135Medicare PIN