# BLUE RIDGE UROLOGY PA

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

## Provider details

- **NPI number:** 1487751699
- **Authorized official:** DR. JOHN E WALTON MD (OWNER)
- **Authorized official phone:** (864) 877-0779

## Contact information

- **Practice address:** 402 MEMORIAL DRIVE EXTENSION, GREER, SC 29651
- **Practice address phone:** (864) 877-0779
- **Practice address fax:** (864) 877-7801
- **Mailing address:** 402 MEMORIAL DRIVE EXTENSION, GREER, SC 29651
- **Mailing address phone:** (864) 877-0779
- **Mailing address fax:** (864) 877-7801

## Taxonomy

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

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 89014MU | MEDICAID | NC |
| 05 | — | GP3677 | — | SC |