Healthcare Provider Details

I. General information

NPI: 1497035612
Provider Name (Legal Business Name): MYRIAM J SOLLMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RICHLAND MEDICAL PARK DR STE 310
COLUMBIA SC
29203-6862
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-8323
  • Fax: 803-434-8326
Mailing address:
  • Phone: 803-296-7320
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number4159
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number63
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: