Healthcare Provider Details

I. General information

NPI: 1326512633
Provider Name (Legal Business Name): PAUL ELLIOTT ROBINSON JR. BI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2019
Last Update Date: 01/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 WHITTAKER PKWY
ORANGEBURG SC
29115-6248
US

IV. Provider business mailing address

PO BOX 682
ORANGEBURG SC
29116-0682
US

V. Phone/Fax

Practice location:
  • Phone: 803-531-2063
  • Fax:
Mailing address:
  • Phone: 803-682-5027
  • Fax: 803-531-3041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number3377
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: