Healthcare Provider Details

I. General information

NPI: 1083482269
Provider Name (Legal Business Name): ZARIEL A YEARGIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 12/18/2023
Certification Date: 12/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 WHEAT ST
COLUMBIA SC
29201
US

IV. Provider business mailing address

1434 FORT LINDLEY RD
LAURENS SC
29360-7245
US

V. Phone/Fax

Practice location:
  • Phone: 864-981-3052
  • Fax:
Mailing address:
  • Phone: 864-981-3052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: