Healthcare Provider Details

I. General information

NPI: 1528352291
Provider Name (Legal Business Name): PAYTON BLAIR FOUST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3799 12TH STREET EXTENSION STE 105
CAYCE SC
29033
US

IV. Provider business mailing address

PO BOX 6069
WEST COLUMBIA SC
29171-6069
US

V. Phone/Fax

Practice location:
  • Phone: 803-926-6820
  • Fax:
Mailing address:
  • Phone: 803-926-6820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33590
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: