Individual
ELIJAH SCOTT BAUSUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGNP-C
Contact information
Practice address
1285 WILSON HALL RD, SUMTER, SC 29150-1804
(803) 905-3555
Mailing address
704 HAILE ST, SUMTER, SC 29150-3144
(803) 464-2698
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
28689
SC
Other
Enumeration date
04/30/2024
Last updated
04/30/2024
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