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General NPI Number Information
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NPI Number | 1902368251
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Entity Type | Individual
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Provider Name | MR. CANDLER GRADY MATHEWS III
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Gender | Male
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Dates
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Enumeration Date | 04/04/2019
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 120 GATEWAY CORPORATE BLVD
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City | COLUMBIA
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State | SC
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Zip | 29203-9611
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Country | US
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Telephone | 803-865-4500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 23321
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City | NEW YORK
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State | NY
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Zip | 10087-4321
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Country | US
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Telephone | 803-840-3619
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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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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 94309
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License Number State | SC
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