Organization
LAKESIDE ORTHOPAEDIC CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID WOODBURY MD (OWNER)
(803) 433-5633
Entity
Organization
Contact information
Practice address
50 E HOSPITAL ST, SUITE 6, MANNING, SC 29102-3149
(803) 433-5633
(803) 433-5636
Mailing address
50 E HOSPITAL ST, SUITE 6, MANNING, SC 29102-3149
(803) 433-5633
(803) 433-5636
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
27593
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
275936
—
SC
05
—
GP4233
—
SC
Enumeration date
12/22/2005
Last updated
07/27/2012
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