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General NPI Number Information
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NPI Number | 1477496651
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Entity Type | Individual
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Provider Name | BLAKE E BAGWELL
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Gender | Male
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Dates
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Enumeration Date | 04/13/2026
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Last Update Date | 04/13/2026
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Provider Practice Location Address
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Address Line | 2543 LOCUST HILL RD
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City | TAYLORS
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State | SC
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Zip | 29687-5835
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Country | US
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Telephone | 864-879-9898
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Fax |
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Provider Business Mailing Address
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Address Line | 400 MEMORIAL DRIVE EXT STE 400
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City | GREER
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State | SC
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Zip | 29651-1850
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Country | US
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Telephone | 864-517-3698
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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