Individual
MR. EDWARD CLARK BURNSIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1028 EWALL ST, MT PLEASANT, SC 29464-3046
(843) 573-0499
(843) 388-6292
Mailing address
PO BOX 81113, ASHLEY RIVER STATION, CHARLESTON, SC 29416-1113
(843) 573-0499
(843) 388-6298
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
TL 1511
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TL 1511
SC STATE TEMP LICENSE
SC
Enumeration date
03/02/2010
Last updated
03/02/2010
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