Healthcare Provider Details

I. General information

NPI: 1508547753
Provider Name (Legal Business Name): SOPIO MOTSONELIDZE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 UNIVERSITY PKWY
AIKEN SC
29801-6302
US

IV. Provider business mailing address

225 RICHARDSON ST APT 4105
CAYCE SC
29033-4437
US

V. Phone/Fax

Practice location:
  • Phone: 803-641-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number90606
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: