Healthcare Provider Details

I. General information

NPI: 1013021153
Provider Name (Legal Business Name): EDMUND S. HIGGINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 CHERAW ST.
BENNETTSVILLE SC
29512
US

IV. Provider business mailing address

P.O. BOX 918 1035 CHERAW ST.
BENNETTSVILLE SC
29512
US

V. Phone/Fax

Practice location:
  • Phone: 843-556-4157
  • Fax: 843-763-8747
Mailing address:
  • Phone: 843-454-0841
  • Fax: 843-454-0635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number12478
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD12478
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: