Healthcare Provider Details

I. General information

NPI: 1417812736
Provider Name (Legal Business Name): BRYSON MILES SKELTON CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S FISH TRAP RD
GREENVILLE SC
29611-7042
US

IV. Provider business mailing address

515 S FISH TRAP RD
GREENVILLE SC
29611-7042
US

V. Phone/Fax

Practice location:
  • Phone: 828-696-1000
  • Fax:
Mailing address:
  • Phone: 828-696-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number198542
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: