Healthcare Provider Details

I. General information

NPI: 1346244951
Provider Name (Legal Business Name): JAMES BRYANT EDWARDS III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 N FRASER ST
GEORGETOWN SC
29440-2800
US

IV. Provider business mailing address

1306 N FRASER ST
GEORGETOWN SC
29440-2800
US

V. Phone/Fax

Practice location:
  • Phone: 843-546-3132
  • Fax: 843-546-2268
Mailing address:
  • Phone: 843-546-3132
  • Fax: 843-546-2268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number5875
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: