Organization
WEIGHT SHOP
Active
Parent organization
BRANDON L DANIELS M.D.
Organization subpart
Yes
Provider details
NPI number
Legal business name
BRANDON L DANIELS M.D.
Authorized official
PAMELA YVONNE GRIMMETT (ACCOUNT MANAGER)
(208) 267-1202
Entity
Organization
Contact information
Practice address
953 DOUGHERTY RD, AIKEN, SC 29803-6508
(803) 644-1970
(803) 644-1790
Mailing address
953 DOUGHERTY RD, AIKEN, SC 29803-6508
(803) 644-1970
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
TL30852
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
308526
—
SC
Enumeration date
03/18/2010
Last updated
03/18/2010
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