Healthcare Provider Details

I. General information

NPI: 1598686917
Provider Name (Legal Business Name): BAELY AUSTIN ERICKSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 DUNBARTON DR APT 115
FLORENCE SC
29501-1941
US

IV. Provider business mailing address

250 DUNBARTON DR APT 115
FLORENCE SC
29501-1941
US

V. Phone/Fax

Practice location:
  • Phone: 901-838-0716
  • Fax:
Mailing address:
  • Phone: 901-838-0716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberLL97270
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: