Healthcare Provider Details

I. General information

NPI: 1487392429
Provider Name (Legal Business Name): JOHN CHARLES EBERT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 BULL ST
COLUMBIA SC
29201-2506
US

IV. Provider business mailing address

1824 BULL ST
COLUMBIA SC
29201-2506
US

V. Phone/Fax

Practice location:
  • Phone: 803-250-5107
  • Fax: 803-708-4041
Mailing address:
  • Phone: 803-250-5107
  • Fax: 803-708-4041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: