Healthcare Provider Details

I. General information

NPI: 1922267749
Provider Name (Legal Business Name): VIRGINIA PATE HENDERSON M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 PINNACLE POINT DR STE 100
COLUMBIA SC
29223-5740
US

IV. Provider business mailing address

1517 DEANS LN
COLUMBIA SC
29205-1531
US

V. Phone/Fax

Practice location:
  • Phone: 803-381-6517
  • Fax:
Mailing address:
  • Phone: 803-381-6517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number30924
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLL30924
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: