Organization
EDISTO UROLOGICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM WALTON MIMS M.D. (OWNER)
(803) 534-4611
Entity
Organization
Contact information
Practice address
1175 COOK RD STE 310, ORANGEBURG, SC 29118-8201
(803) 534-4611
(803) 534-7269
Mailing address
1175 COOK RD STE 310, ORANGEBURG, SC 29118-8201
(803) 534-4611
(803) 534-7269
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
5227
SC
Other
Enumeration date
11/14/2007
Last updated
11/14/2007
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