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General NPI Number Information
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NPI Number | 1487751699
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE UROLOGY PA
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 402 MEMORIAL DRIVE EXTENSION
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City | GREER
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State | SC
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Zip | 29651
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Country | US
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Telephone | 864-877-0779
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Fax | 864-877-7801
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Provider Business Mailing Address
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Address Line | 402 MEMORIAL DRIVE EXTENSION
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City | GREER
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State | SC
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Zip | 29651
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Country | US
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Telephone | 864-877-0779
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Fax | 864-877-7801
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN E WALTON
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Credential | MD
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Telephone | 864-877-0779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State | SC
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