Organization
SOUTH CAROLINA PODIATRIC PHYSICIANS AND SURGEONS GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON PERCIVAL (PRESIDENT)
(803) 285-1411
Entity
Organization
Contact information
Practice address
1120 GLENNS BAY RD, SUITE 103, SURFSIDE BEACH, SC 29575-4757
(843) 449-8079
(843) 497-6147
Mailing address
8141 ROURK ST, MYRTLE BEACH, SC 29572-4128
(843) 449-8079
(843) 497-6147
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
SC
213ES0103X
Foot & Ankle Surgery Podiatrist
—
SC
213ES0131X
Foot Surgery Podiatrist
—
SC
Other
Enumeration date
03/09/2014
Last updated
03/16/2014
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