Healthcare Provider Details

I. General information

NPI: 1568586790
Provider Name (Legal Business Name): ANGELA HAMPTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

498 NORTH ST
BAMBERG SC
29003-1377
US

IV. Provider business mailing address

3310 MAGNOLIA ST
ORANGEBURG SC
29115-1466
US

V. Phone/Fax

Practice location:
  • Phone: 803-395-3600
  • Fax:
Mailing address:
  • Phone: 803-531-6900
  • Fax: 803-531-6907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number492
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberA492
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: