# EDISTO UROLOGICAL ASSOCIATES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063692457
- **Authorized official:** DR. WILLIAM WALTON MIMS M.D. (OWNER)
- **Authorized official phone:** (803) 534-4611

## Contact information

- **Practice address:** 1175 COOK RD STE 310, ORANGEBURG, SC 29118-8201
- **Practice address phone:** (803) 534-4611
- **Practice address fax:** (803) 534-7269
- **Mailing address:** 1175 COOK RD STE 310, ORANGEBURG, SC 29118-8201
- **Mailing address phone:** (803) 534-4611
- **Mailing address fax:** (803) 534-7269

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | 5227 | SC | Yes |

## Other

- **Enumeration date:** 11/14/2007
- **Last updated:** 11/14/2007