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General NPI Number Information
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NPI Number | 1497078067
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Entity Type | Organization
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Legal Business Name | CAROLINA FAMILY UROLOGY
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Dates
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Enumeration Date | 03/10/2010
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Last Update Date | 03/10/2010
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Provider Practice Location Address
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Address Line | 109 BURTON AVE STE F
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City | SUMMERVILLE
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State | SC
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Zip | 29485-8117
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Country | US
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Telephone | 843-871-5220
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Fax | 843-871-5547
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Provider Business Mailing Address
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Address Line | 109 BURTON AVE STE F
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City | SUMMERVILLE
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State | SC
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Zip | 29485-8117
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Country | US
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Telephone | 843-871-5220
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Fax | 843-871-5547
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Authorized Official
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Title or Position | OWNER
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Name | DAVID W BRANDLI
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Credential | MD
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Telephone | 843-871-5220
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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 | 23790
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License Number State | SC
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