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General NPI Number Information
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NPI Number | 1982347605
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Entity Type | Individual
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Provider Name | LEWANDOSKI DEJUAN BRYSON II
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Gender | Male
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Dates
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Enumeration Date | 04/20/2022
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 3209 COLONIAL DR
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City | COLUMBIA
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State | SC
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Zip | 29203-6930
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Country | US
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Telephone | 803-434-6113
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Fax | 803-434-7231
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE STE 300
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City | GREENVILLE
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State | SC
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Zip | 29601-2899
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Country | US
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Telephone | 864-522-8611
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 88078
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | LL88078
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License Number State | SC
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