Healthcare Provider Details

I. General information

NPI: 1285647776
Provider Name (Legal Business Name): CHARLES WALTON BOYTER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6439 GARNERS FERRY RD
COLUMBIA SC
29209-1638
US

IV. Provider business mailing address

856 HAMPTON CREEK WAY
COLUMBIA SC
29209-5419
US

V. Phone/Fax

Practice location:
  • Phone: 803-776-4000
  • Fax: 803-695-6749
Mailing address:
  • Phone: 803-210-7944
  • Fax: 803-695-6749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11714
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: