Basic Information
| Provider Information | |||||||||
| NPI: | 1952374316 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRASWELL | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1245 | ||||||||
| Address2: | |||||||||
| City: | ORANGEBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291161245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033954497 | ||||||||
| FaxNumber: | 8035360998 | ||||||||
| Practice Location | |||||||||
| Address1: | 526 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | BAMBERG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290031319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032452433 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 03/21/2017 | ||||||||
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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 | 9917 | NM | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 28400 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 83607501 | 05 | NM | MEDICAID |