Healthcare Provider Details

I. General information

NPI: 1790761609
Provider Name (Legal Business Name): LEE GRANGER BECKWITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 FOREST DR
COLUMBIA SC
29204-2026
US

IV. Provider business mailing address

PO BOX 23321
NEW YORK NY
10087-4321
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number64720
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number17972
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number101537
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: