Healthcare Provider Details

I. General information

NPI: 1851141162
Provider Name (Legal Business Name): CAMERON JAMES PRILLHART D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 COLONIAL DR
COLUMBIA SC
29203-6930
US

IV. Provider business mailing address

3209 COLONIAL DR
COLUMBIA SC
29203-6930
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-7399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLL91525
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: