Provider Demographics
NPI:1457728032
Name:FLOWERTOWN PODIATRY, INC
Entity Type:Organization
Organization Name:FLOWERTOWN PODIATRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON-HORNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:843-376-5348
Mailing Address - Street 1:498 DOLPHIN DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-4181
Mailing Address - Country:US
Mailing Address - Phone:843-376-5348
Mailing Address - Fax:843-353-2605
Practice Address - Street 1:4340 LADSON RD STE C
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-6444
Practice Address - Country:US
Practice Address - Phone:843-851-9069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC595213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1073670493OtherINDIVIDUAL NPI
SCU751810004Medicare UPIN