Healthcare Provider Details

I. General information

NPI: 1568193456
Provider Name (Legal Business Name): MRS. ANDREA HUGHES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 ROBERTS BRANCH PKWY STE 106
COLUMBIA SC
29203-9150
US

IV. Provider business mailing address

961 ROBERTS BRANCH PKWY STE 106
COLUMBIA SC
29203-9150
US

V. Phone/Fax

Practice location:
  • Phone: 803-743-8814
  • Fax: 864-383-6778
Mailing address:
  • Phone: 803-743-8814
  • Fax: 863-383-6778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: