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General NPI Number Information
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NPI Number | 1033160254
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Entity Type | Individual
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Provider Name | BAXTER MCLENDON M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 333 REVOLUTIONARY TRL
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City | FAIRFAX
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State | SC
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Zip | 29827-7109
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Country | US
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Telephone | 803-632-2533
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Fax | 803-632-2451
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Provider Business Mailing Address
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Address Line | PO BOX 599
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City | BRUNSON
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State | SC
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Zip | 29911-0599
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Country | US
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Telephone | 803-632-1699
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Fax | 803-632-2451
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 6266
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 6266
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License Number State | SC
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