=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477874634
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH CAROLINA PUBLIC CHARTER SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2010
-----------------------------------------------------
Last Update Date | 06/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3700 FOREST DR SUITE 406
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29204-4010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-734-8233
-----------------------------------------------------
Fax | 803-734-8325
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3700 FOREST DR SUITE 406
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29204-4010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-734-8233
-----------------------------------------------------
Fax | 803-734-8325
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUPERINTENDENT
-----------------------------------------------------
Name | MR. DARRYL WAYNE BRAZELL
-----------------------------------------------------
Credential | PH.D
-----------------------------------------------------
Telephone | 803-734-8322
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number | 2412039000
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------