Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 10996 | SC |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 10996 | SC |
N | 207XS0117X | Orthopaedic Spine Surgeon | 26438 | NC |
NPI | 1134129216 |
---|---|
Provider Name | Dr. Willie Stanley Edwards JR. |
First Address | Florence, SC 29502-3239 |
Second Address | Florence, SC 29506-2653 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 03/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
109965 | (05) | SC |
8930169 | (05) | NC |
C60418 | (02) | SC |