Edward Demond Bracey
Individual provider Active NPI Driver · Blythewood, SC
NPI 1801634464 · NPPES record last updated Jul 17, 2024
Key facts
- NPI
- 1801634464
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- 0073603575 (SC)
- Practice address
- 9923 Wilson Blvd
Blythewood, SC 29016-9022 - Phone
- (839) 810-8443
- NPI assigned
- Jul 17, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0073603575 | SC | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 0073603575 | SC | Yes |
Addresses
Primary practice location
9923 Wilson Blvd
Blythewood, SC 29016-9022
Mailing address
9923 Wilson Blvd
Blythewood, SC 29016-9022
Phone (839) 810-8443
Other providers in Blythewood, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.