# SOUTH CAROLINA PODIATRIC PHYSICIANS AND SURGEONS GROUP, LLC

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

## Provider details

- **NPI number:** 1699190272
- **Authorized official:** BRANDON PERCIVAL DPM (PRESIDENT)
- **Authorized official phone:** (803) 285-1411

## Contact information

- **Practice address:** 9789 CHARLOTTE HWY STE 200, FORT MILL, SC 29707-7182
- **Practice address phone:** (803) 548-3338
- **Mailing address:** 8141 ROURK ST, MYRTLE BEACH, SC 29572-4128
- **Mailing address phone:** (843) 492-2293
- **Mailing address fax:** (888) 383-6797

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |

## Other

- **Enumeration date:** 02/19/2014
- **Last updated:** 07/18/2014