Provider Demographics
NPI:1992817092
Name:MAYER, DENNIS EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:EDWARD
Last Name:MAYER
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:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:1690 SKYLYN DR STE 350
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1039
Practice Address - Country:US
Practice Address - Phone:864-577-1600
Practice Address - Fax:864-577-1645
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40932208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG836871Medicaid
H07182Medicare UPIN
G83687Medicare ID - Type Unspecified