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General NPI Number Information
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NPI Number | 1598777864
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Entity Type | Individual
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Provider Name | BRODIE EDEN MCKOY M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 851 LEONARD FULGHUM BLVD SUITE 101
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City | MT PLEASANT
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State | SC
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Zip | 29464-3787
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Country | US
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Telephone | 843-971-9750
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Fax | 843-971-9351
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Provider Business Mailing Address
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Address Line | 851 LEONARD FULGHUM DR 101
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City | MOUNT PLEASANT
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State | SC
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Zip | 29464-3793
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Country | US
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Telephone | 843-971-9350
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Fax | 843-971-9351
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 20250
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License Number State | SC
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