Healthcare Provider Details

I. General information

NPI: 1487722559
Provider Name (Legal Business Name): MYERS PODIATRY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 04/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 E HIGHWAY 76 MEDICAL PARK 2, STE 1
MULLINS SC
29574-6037
US

IV. Provider business mailing address

2845 E HIGHWAY 76 MEDICAL PARK 2, STE 1
MULLINS SC
29574-6037
US

V. Phone/Fax

Practice location:
  • Phone: 843-431-2780
  • Fax:
Mailing address:
  • Phone: 843-431-2780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC 531
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberSC 531
License Number StateSC

VIII. Authorized Official

Name: DR. WILLIAM CHARLES MYERS JR.
Title or Position: OWNER
Credential: DPM
Phone: 843-431-2780