Healthcare Provider Details

I. General information

NPI: 1346468204
Provider Name (Legal Business Name): GRACE MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/17/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 FARROW RD
COLUMBIA SC
29203
US

IV. Provider business mailing address

3025 FARROW RD
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 803-933-0288
  • Fax: 803-933-9920
Mailing address:
  • Phone: 803-933-0288
  • Fax: 803-933-9920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number12184
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number13924
License Number StateSC

VIII. Authorized Official

Name: DR. CYNTHIA MATHEWS-BETTS
Title or Position: MD
Credential: MD
Phone: 803-933-0288