Healthcare Provider Details

I. General information

NPI: 1790736809
Provider Name (Legal Business Name): EDWARD WARREN III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 W CAROLINA AVE
VARNVILLE SC
29944-4735
US

IV. Provider business mailing address

595 W CAROLINA AVE
VARNVILLE SC
29944-4735
US

V. Phone/Fax

Practice location:
  • Phone: 803-943-7600
  • Fax: 803-943-7601
Mailing address:
  • Phone: 803-943-7600
  • Fax: 803-943-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number07713
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: