Healthcare Provider Details

I. General information

NPI: 1053359851
Provider Name (Legal Business Name): AYANNA SWINTON JAMISON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 READ ST STE I-10
COLUMBIA SC
29204-7861
US

IV. Provider business mailing address

2601 READ ST STE I-10
COLUMBIA SC
29204-7861
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-0101
  • Fax: 800-854-3497
Mailing address:
  • Phone: 803-256-0101
  • Fax: 800-854-3497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number22943
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: