Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 204R00000X | Electrodiagnostic Medicine | | | SOUTH CAROLINA | No |
| 2 | 363AS0400X | Physician Assistant | Surgical | | | No |
| 3 | 207XS0106X | Orthopaedic Surgery | Hand Surgery | | | No |
| 4 | 207XS0114X | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | | | No |
| 5 | 207XS0117X | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | | | No |
| 6 | 207XX0004X | Orthopaedic Surgery | Foot and Ankle Surgery | | | No |
| 7 | 207XX0005X | Orthopaedic Surgery | Sports Medicine | | | No |
| 8 | 208100000X | Physical Medicine & Rehabilitation | | | SOUTH CAROLINA | No |
| 9 | 2081P2900X | Physical Medicine & Rehabilitation | Pain Medicine | | | No |
| 10 | 363A00000X | Physician Assistant | | | | No |
| 11 | 363AM0700X | Physician Assistant | Medical | | | No |
| 12 | 363LA2200X | Nurse Practitioner | Adult Health | | | No |
| 13 | 363LF0000X | Nurse Practitioner | Family | | | No |
| 14 | 207X00000X | Orthopaedic Surgery | | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | GP6337 | MEDICAID | SOUTH CAROLINA | |
| 2 | 45168 | OTHER | SOUTH CAROLINA | MULTIPLAN MPI GROUP # |
| 3 | 42D2000692 | OTHER | SOUTH CAROLINA | CLIA |
| 4 | DU4331 | OTHER | SOUTH CAROLINA | RAILROAD MEDICARE GROUP PTAN # |
