Healthcare Provider Details

I. General information

NPI: 1508493818
Provider Name (Legal Business Name): AMY GAO XIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 OTARRE PKWY
CAYCE SC
29033-3751
US

IV. Provider business mailing address

400 OTARRE PKWY
CAYCE SC
29033-3751
US

V. Phone/Fax

Practice location:
  • Phone: 803-898-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number95164
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD61499353
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: