Individual
CODY CLARKE ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
241 KELLEY ST, LAKE CITY, SC 29560-2446
(843) 519-2399
(843) 519-0234
Mailing address
PO BOX 3239, FLORENCE, SC 29502-3239
(843) 519-2399
(843) 519-0234
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
061.0000023
VT
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
713
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SCJ236
—
SC
Enumeration date
06/12/2017
Last updated
11/12/2022
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