Healthcare Provider Details

I. General information

NPI: 1285491225
Provider Name (Legal Business Name): VIZER WELLNESS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7356 GARNERS FERRY RD STE 128
COLUMBIA SC
29209-2146
US

IV. Provider business mailing address

PO BOX 141
SUMTER SC
29151-0141
US

V. Phone/Fax

Practice location:
  • Phone: 803-580-4747
  • Fax:
Mailing address:
  • Phone: 803-580-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY DIANNE BILLIE JACKSON
Title or Position: OWNER
Credential: APRN
Phone: 803-580-4747