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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 PERCIVAL (PRESIDENT)
(803) 285-1411
Entity
Organization
Contact information
Practice address
1120 GLENNS BAY RD, SUITE 103, SURFSIDE BEACH, SC 29575-4757
(843) 449-8079
(843) 497-6147
Mailing address
8141 ROURK ST, MYRTLE BEACH, SC 29572-4128
(843) 449-8079
(843) 497-6147
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
03/09/2014
Last updated
03/16/2014
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