| Organization Name: | SOUTH CAROLINA PODIATRIC PHYSICIANS AND SURGEONS GROUP, LLC |
| NPI Number: | 1063837870 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRANDON PERCIVAL (PRESIDENT) |
| Mailing Address: | 912 Inlet Square Dr Murrells Inlet |
| State: | SC US |
| Postal Code: | 295767812 |
| Phone Number: | 8433473334 |
| Fax Number: | 8434312786 |
| NPI Enumeration Date: | 03/03/2014 |
| NPI Last Update Date: | 03/03/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 531 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |