Healthcare Provider Details

I. General information

NPI: 1356582597
Provider Name (Legal Business Name): LOWCOUNTRY SPINE & SPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NEW RIVER PKWY BUILDING 2, SUITE 37
HARDEEVILLE SC
29927-4450
US

IV. Provider business mailing address

300 NEW RIVER PKWY BUILDING 2, SUITE 37
HARDEEVILLE SC
29927-4450
US

V. Phone/Fax

Practice location:
  • Phone: 843-422-0781
  • Fax: 800-210-2452
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number22310
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number22310
License Number StateSC

VIII. Authorized Official

Name: JOHN P BATSON III
Title or Position: OWNER
Credential: M.D.
Phone: 843-422-0781