Healthcare Provider Details

I. General information

NPI: 1952374316
Provider Name (Legal Business Name): WILLIAM N BRASWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 NORTH ST
BAMBERG SC
29003-1319
US

IV. Provider business mailing address

PO BOX 1245
ORANGEBURG SC
29116-1245
US

V. Phone/Fax

Practice location:
  • Phone: 803-245-2433
  • Fax:
Mailing address:
  • Phone: 803-395-4497
  • Fax: 803-536-0998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9917
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28400
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: