Healthcare Provider Details

I. General information

NPI: 1356458061
Provider Name (Legal Business Name): WILLIAM C. ALDRICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 PROFESSIONAL CT
MANNING SC
29102-2827
US

IV. Provider business mailing address

1036 PROFESSIONAL CT
MANNING SC
29102-2827
US

V. Phone/Fax

Practice location:
  • Phone: 803-773-5227
  • Fax: 803-746-7445
Mailing address:
  • Phone: 803-433-5220
  • Fax: 803-433-5221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13915
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: