Provider Demographics
NPI:1801866181
Name:BISHOP, PRESTON EDDIE (MD)
Entity Type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:EDDIE
Last Name:BISHOP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:7221 S PINE ST
Practice Address - Street 2:
Practice Address - City:PACOLET
Practice Address - State:SC
Practice Address - Zip Code:29372-3122
Practice Address - Country:US
Practice Address - Phone:864-474-1528
Practice Address - Fax:864-474-1049
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD6333OtherMEDCOST
SC3580315OtherAETNA
SC210355Medicaid
SCG910365193Medicare PIN
SCG91036Medicare UPIN
SCP00190087Medicare PIN