Individual
CHARLES KENNETH EDSALL I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
100 HEALTHY WAY STE 1200, ANDERSON, SC 29621
(864) 512-6140
(864) 512-6149
Mailing address
PO BOX 100174, COLUMBIA, SC 29202-3174
(864) 512-6140
(864) 512-6149
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
29929
SC
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
29929
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1841483344
NPI
SC
05
—
299297
—
SC
Enumeration date
08/20/2007
Last updated
11/23/2022
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