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Organization
SOUTH CAROLINA PODIATRIC PHYSICIANS AND SURGEONS GROUP,LLC
Active
Organization
SOUTH CAROLINA PODIATRIC PHYSICIANS AND SURGEONS GROUP,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON S PERCIVAL (PRESIDENT)
(803) 285-1411
Entity
Organization
Contact information
Practice address
8020 MYRTLE TRACE DR, CONWAY, SC 29526-8945
(843) 234-9100
(843) 234-9103
Mailing address
8141 ROURK ST, MYRTLE BEACH, SC 29572-4128
(803) 285-1411
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
SC
213ES0103X
Foot & Ankle Surgery Podiatrist
—
SC
213ES0131X
Foot Surgery Podiatrist
—
SC
Other
Enumeration date
03/20/2014
Last updated
03/20/2014
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