Healthcare Provider Details

I. General information

NPI: 1821009077
Provider Name (Legal Business Name): SOUTH CAROLINA NEUROLOGICAL CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 TAYLOR ST SUITE 1-C
COLUMBIA SC
29201-2923
US

IV. Provider business mailing address

PO BOX 1488
COLUMBIA SC
29202-1488
US

V. Phone/Fax

Practice location:
  • Phone: 803-254-6391
  • Fax: 803-799-0682
Mailing address:
  • Phone: 803-254-6391
  • Fax: 803-799-0682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: JUDSON H. JOHNSON SR.
Title or Position: ADMINISTRATOR
Credential:
Phone: 803-254-6391