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NPI Code Detail

MEDICARE: BRANDON WALKER WHITWORTH

MEDICARE: BRANDON WALKER WHITWORTH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist8149SC

General Provider Information

NPI Number : 1649522202
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON WALKER WHITWORTH
Provider Business Mailing Address
First Line : 1040 S. PENDLETON ST UNIT C
Second Line :
City : EASLEY
State : SC
Zip : 29642
Country : US
Telephone Number : 864-306-0800
Fax Number :
Provider Business Practice Location Address
First Line : 1040 S PENDLETON ST STE C
Second Line :
City : EASLEY
State : SC
Zip : 29642-1047
Country : US
Telephone Number : 864-306-0800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2012
Last Update Date : 10/08/2012

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Directions to “ BRANDON WALKER WHITWORTH ” Practice Location

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