Healthcare Provider Details

I. General information

NPI: 1770730699
Provider Name (Legal Business Name): MR. WALTER CURRY JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 S BELTLINE BLVD APT F15
COLUMBIA SC
29205-4269
US

IV. Provider business mailing address

504 S BELTLINE BLVD APT F15
COLUMBIA SC
29205-4269
US

V. Phone/Fax

Practice location:
  • Phone: 803-404-9088
  • Fax:
Mailing address:
  • Phone: 803-404-9088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number423254
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: