Healthcare Provider Details

I. General information

NPI: 1619744398
Provider Name (Legal Business Name): GRACE MEDICAL OF AIKEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 BARNWELL AVE NW
AIKEN SC
29801-3937
US

IV. Provider business mailing address

PO BOX 537
AIKEN SC
29802-0537
US

V. Phone/Fax

Practice location:
  • Phone: 803-226-0274
  • Fax: 803-226-0436
Mailing address:
  • Phone: 803-226-0274
  • Fax: 803-226-0436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANNA ALLMAN
Title or Position: OWNER
Credential: NP
Phone: 803-270-1101