MEDICARE: DR. BRENT T FOLSOM MD

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
1	207N00000X	Dermatology Physician	207N00000X	SC
2	207ND0101X	MOHS-Micrographic Surgery Physician	91415	SC

General Provider Information

NPI Number	:	1851928410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENT T FOLSOM MD

Provider Business Mailing Address
First Line	:	890 BIRDS ML SE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-5139
Country	:	US
Telephone Number	:	616-581-1913
Fax Number	:

Provider Business Practice Location Address
First Line	:	5046 HIGHWAY 17 BYP S STE 200
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-4503
Country	:	US
Telephone Number	:	843-839-3501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2020
Last Update Date	:	12/01/2025

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