Healthcare Provider Details

I. General information

NPI: 1821086695
Provider Name (Legal Business Name): SHARON PHILLIPS BEALL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY SHARON PHILLIPS

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 STONEMARK LN STE 100
COLUMBIA SC
29210-3881
US

IV. Provider business mailing address

136 STONEMARK LN STE 100
COLUMBIA SC
29210-3881
US

V. Phone/Fax

Practice location:
  • Phone: 803-603-4821
  • Fax: 888-802-6138
Mailing address:
  • Phone: 803-603-4821
  • Fax: 888-802-6138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number34097
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: