Healthcare Provider Details

I. General information

NPI: 1528443348
Provider Name (Legal Business Name): MR. MARK ARIAIL SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MARK ARIAIL SR. RN

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 ANSON DR
COLUMBIA SC
29229-7434
US

IV. Provider business mailing address

630 ANSON DR
COLUMBIA SC
29229-7434
US

V. Phone/Fax

Practice location:
  • Phone: 803-920-7846
  • Fax:
Mailing address:
  • Phone: 803-776-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number67311
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: