Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 3641 | SC |
Y | 213ES0000X | Sports Medicine | 3641 | SC |
NPI | 1558889980 |
---|---|
Provider Name | Brandon Lee Edwards |
First Address | Florence, SC 29501-3904 |
Second Address | Florence, SC 29501-3904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2017 |
Last Update Date | 06/09/2017 |