Healthcare Provider Details

I. General information

NPI: 1477073971
Provider Name (Legal Business Name): BRADLEY SCOTT EDMONDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MEDICAL PARK, STE 141 GENERAL PSYCHIATRY DEPT
COLUMBIA SC
29203
US

IV. Provider business mailing address

15 MEDICAL PARK, STE 141 GENERAL PSYCHIATRY DEPT
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-1433
  • Fax: 803-434-4062
Mailing address:
  • Phone: 803-434-1433
  • Fax: 803-434-4062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberLL40893
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: