Organization
CAROLINA PODIATRY GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRANDON S PERCIVAL D.P.M. (PODIATRIST)
(803) 285-1411
Entity
Organization
Contact information
Practice address
102 HWY 321 BYPASS NORTH, WINNSBORO, SC 29180
(800) 336-1279
(803) 283-9920
Mailing address
PO BOX 325, LANCASTER, SC 29721-0325
(803) 285-1411
(800) 328-3992
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP9980
—
SC
05
—
PD5364
—
SC
05
—
PD5408
—
SC
Enumeration date
03/13/2007
Last updated
02/28/2008
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