Healthcare Provider Details

I. General information

NPI: 1437579778
Provider Name (Legal Business Name): ANISH ATULKUMAR BRAHMBHATT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2014
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 BLACK RIVER RD
GEORGETOWN SC
29440-3304
US

IV. Provider business mailing address

4561 FARM LAKE DR
MYRTLE BEACH SC
29579-6599
US

V. Phone/Fax

Practice location:
  • Phone: 843-527-7000
  • Fax: 843-520-8403
Mailing address:
  • Phone: 304-388-5590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number40684
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: