Healthcare Provider Details

I. General information

NPI: 1598215899
Provider Name (Legal Business Name): SYLVIA BUNDOTICH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 MEDICAL CENTER DRIVE, SUITE A2 SC HOUSE CALLS INC
AUGUSTA GA
30909
US

IV. Provider business mailing address

1053 CENTER STREET SC HOUSE CALLS INC
WEST COLUMBIA SC
29169
US

V. Phone/Fax

Practice location:
  • Phone: 800-491-0909
  • Fax: 855-632-8329
Mailing address:
  • Phone: 800-491-0909
  • Fax: 855-632-8329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3010531
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN285818
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: