Healthcare Provider Details

I. General information

NPI: 1275707309
Provider Name (Legal Business Name): OGHENERUONA OSEHI ODILI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OGHENERUONA O. APOE

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RICHLAND MEDICAL PARK DR STE 420
COLUMBIA SC
29203-6833
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-6430
  • Fax: 803-545-5353
Mailing address:
  • Phone: 803-296-7320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2008-01872
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number32524
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2008-01872
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2008-01872
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: