Organization
BLUE RIDGE UROLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN E WALTON MD (OWNER)
(864) 877-0779
Entity
Organization
Contact information
Practice address
402 MEMORIAL DRIVE EXTENSION, GREER, SC 29651
(864) 877-0779
(864) 877-7801
Mailing address
402 MEMORIAL DRIVE EXTENSION, GREER, SC 29651
(864) 877-0779
(864) 877-7801
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
89014MU
MEDICAID
NC
05
—
GP3677
—
SC
Enumeration date
09/20/2006
Last updated
07/21/2022
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