Basic Information
| Provider Information | |||||||||
| NPI: | 1215914635 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUMFIELD | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1075 N FRASER ST | ||||||||
| Address2: | GEORGETOWN HEALTH GROUP | ||||||||
| City: | GEORGETOWN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294402848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435274442 | ||||||||
| FaxNumber: | 8435274027 | ||||||||
| Practice Location | |||||||||
| Address1: | 9699 OCEAN HWY | ||||||||
| Address2: | GEORGETOWN HEALTH GROUP | ||||||||
| City: | PAWLEYS ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295857425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432374296 | ||||||||
| FaxNumber: | 8432370495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 02/02/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25249 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | GP1370 | 05 | SC | MEDICAID | GP4819 | 05 | SC | MEDICAID |