Basic Information
| Provider Information | |||||||||
| NPI: | 1730142266 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCELMURRAY | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 56 US HIGHWAY 321 BYP N | ||||||||
| Address2: | |||||||||
| City: | WINNSBORO | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291807100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8036356099 | ||||||||
| FaxNumber: | 8036356343 | ||||||||
| Practice Location | |||||||||
| Address1: | 3209 COLONIAL DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292036930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034346113 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2006 | ||||||||
| LastUpdateDate: | 04/11/2018 | ||||||||
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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 | 10888 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 108886 | 05 | SC | MEDICAID |