Healthcare Provider Details

I. General information

NPI: 1326054917
Provider Name (Legal Business Name): CHARLES D ESKRIDGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PALMETTO HEALTH PKWY SUITE 104
COLUMBIA SC
29212-1753
US

IV. Provider business mailing address

PO BOX 402145
ATLANTA GA
30384-2145
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-5668
  • Fax: 803-434-5669
Mailing address:
  • Phone: 803-296-7322
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number8034
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: