Healthcare Provider Details

I. General information

NPI: 1194902890
Provider Name (Legal Business Name): CAROLINA PODIATRY GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 HIGHWAY 9 BYP W
LANCASTER SC
29720-1709
US

IV. Provider business mailing address

PO BOX 325
LANCASTER SC
29721-0325
US

V. Phone/Fax

Practice location:
  • Phone: 803-285-1411
  • Fax: 803-283-9920
Mailing address:
  • Phone: 803-285-1411
  • Fax: 803-283-9920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. BRANDON SCOT PERCIVAL
Title or Position: OWNER
Credential: DPM
Phone: 803-285-1411