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 | 207XS0106X | Orthopaedic Surgery | Hand Surgery | | SOUTH CAROLINA | No |
| 3 | 207XS0114X | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | | SOUTH CAROLINA | No |
| 4 | 207XS0117X | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | | SOUTH CAROLINA | No |
| 5 | 207XX0004X | Orthopaedic Surgery | Foot and Ankle Surgery | | SOUTH CAROLINA | No |
| 6 | 207XX0005X | Orthopaedic Surgery | Sports Medicine | | SOUTH CAROLINA | No |
| 7 | 208100000X | Physical Medicine & Rehabilitation | | | SOUTH CAROLINA | No |
| 8 | 2081P2900X | Physical Medicine & Rehabilitation | Pain Medicine | | SOUTH CAROLINA | No |
| 9 | 363A00000X | Physician Assistant | | | SOUTH CAROLINA | No |
| 10 | 363AM0700X | Physician Assistant | Medical | | SOUTH CAROLINA | No |
| 11 | 363AS0400X | Physician Assistant | Surgical | | SOUTH CAROLINA | No |
| 12 | 363LA2200X | Nurse Practitioner | Adult Health | | SOUTH CAROLINA | No |
| 13 | 363LF0000X | Nurse Practitioner | Family | | SOUTH CAROLINA | No |
| 14 | 207X00000X | Orthopaedic Surgery | | | SOUTH CAROLINA | 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 | D043 | MEDICARE PIN | SOUTH CAROLINA | |
| 3 | 45168 | OTHER | SOUTH CAROLINA | GROUP MULTIPLAN ID |
| 4 | DU4331 | OTHER | SOUTH CAROLINA | RAILROAD MEDICARE |
