Provider Demographics
NPI:1831185990
Name:RHETT, EDMUND JR (MD)
Entity type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:
Last Name:RHETT
Suffix:JR
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 1:725 LONG POINT RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8226
Mailing Address - Country:US
Mailing Address - Phone:843-375-2210
Mailing Address - Fax:843-375-2214
Practice Address - Street 1:725 LONG POINT ROAD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8226
Practice Address - Country:US
Practice Address - Phone:843-375-2210
Practice Address - Fax:843-375-2214
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8257207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC82573Medicaid
SCB92310Medicare UPIN
SC82573Medicaid