Healthcare Provider Details

I. General information

NPI: 1912574070
Provider Name (Legal Business Name): ALA MOHAMAD AWAD AL-ADAMAT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date: 11/30/2022
Reactivation Date: 12/19/2022

III. Provider practice location address

2 MEDICAL PARK RD STE 501
COLUMBIA SC
29203-6839
US

IV. Provider business mailing address

300 E MCBEE AVE STE 300
GREENVILLE SC
29601-2899
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-3320
  • Fax: 803-933-3036
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number96774
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: