Provider Demographics
NPI:1184645830
Name:BREARLEY, WILLIAM D (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
Last Name:BREARLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 AUGUSTA HWY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2208
Mailing Address - Country:US
Mailing Address - Phone:803-785-4747
Mailing Address - Fax:803-785-4750
Practice Address - Street 1:2006 AUGUSTA HWY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2208
Practice Address - Country:US
Practice Address - Phone:803-785-4747
Practice Address - Fax:803-785-4750
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8596207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC085963Medicaid
SC085963Medicaid