Provider Demographics
NPI:1396734117
Name:BORDENKECHER, COURTNEY DAVIS (DPM)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:DAVIS
Last Name:BORDENKECHER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 EXPRESS LANE
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118
Mailing Address - Country:US
Mailing Address - Phone:803-536-2100
Mailing Address - Fax:803-536-4399
Practice Address - Street 1:135 EXPRESS LANE
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-9501
Practice Address - Country:US
Practice Address - Phone:803-536-2100
Practice Address - Fax:803-536-4399
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000965213ES0103X
SC621213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA086562158Medicaid
GA086562158AMedicaid
48SCCPPMedicare Oscar/Certification
GA086562158AMedicaid
V00477Medicare UPIN