Provider Demographics
NPI:1417342247
Name:RENDON POPE, EMI MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:EMI
Middle Name:MICHELLE
Last Name:RENDON POPE
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:955 RIBAUT RD
Mailing Address - Street 2:BMAC CREDENTIALING
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5441
Mailing Address - Country:US
Mailing Address - Phone:843-770-0404
Mailing Address - Fax:844-296-2308
Practice Address - Street 1:BEAUFORT MEMORIAL LOWCOUNTRY MEDICAL GROUP
Practice Address - Street 2:300 MIDTOWN DRIVE
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906
Practice Address - Country:US
Practice Address - Phone:843-770-0404
Practice Address - Fax:844-296-2308
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC52583207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC525836Medicaid