Healthcare Provider Details

I. General information

NPI: 1316057698
Provider Name (Legal Business Name): BETH ANN WAYWOOD AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 PINNACLE POINT DRIVE
COL SC
29223
US

IV. Provider business mailing address

1040 PINNACLE POINT DRIVE
COLUMBIA SC
29223
US

V. Phone/Fax

Practice location:
  • Phone: 803-509-7200
  • Fax: 803-509-7213
Mailing address:
  • Phone: 803-509-7200
  • Fax: 803-509-7213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002055A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3940
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: