Healthcare Provider Details

I. General information

NPI: 1104997527
Provider Name (Legal Business Name): LOW COUNTRY FAMILY PODIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9313 MEDICAL PLAZA DR SUITE 301
N CHARLESTON SC
29406-9155
US

IV. Provider business mailing address

9313 MEDICAL PLAZA DR SUITE 301
N CHARLESTON SC
29406-9155
US

V. Phone/Fax

Practice location:
  • Phone: 843-553-2909
  • Fax: 843-553-4684
Mailing address:
  • Phone: 843-553-2909
  • Fax: 843-553-4684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number134
License Number StateSC

VIII. Authorized Official

Name: DR. EDWIN BLITCH
Title or Position: PARTNER
Credential: DPM
Phone: 843-553-2909