Healthcare Provider Details

I. General information

NPI: 1902292683
Provider Name (Legal Business Name): GEORGE SIPA ADJAH YANKEY JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 FOREST DR
COLUMBIA SC
29204-2026
US

IV. Provider business mailing address

2435 FOREST DR
COLUMBIA SC
29204-2026
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-5300
  • Fax:
Mailing address:
  • Phone: 803-409-7170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2021-01247
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number90643
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number90643
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: