Individual
EDWARD J MAYEAUX, JR., JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
145 SUNSET CT STE 100, WEST COLUMBIA, SC 29169-2429
(803) 739-3550
(803) 739-3546
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
(803) 739-3550
(803) 739-3546
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
019451
LA
207Q00000X
Family Medicine Physician
Primary
35653
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1901156
—
LA
05
—
356536
—
SC
Enumeration date
07/17/2006
Last updated
01/16/2024
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