Healthcare Provider Details

I. General information

NPI: 1699852160
Provider Name (Legal Business Name): MICHELE FRAZIER M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RICHLAND MEDICAL PARK DR SUITE130
COLUMBIA SC
29203-6849
US

IV. Provider business mailing address

1 WELLNESS BLVD SUITE108
IRMO SC
29063-2871
US

V. Phone/Fax

Practice location:
  • Phone: 803-765-1919
  • Fax: 803-771-9084
Mailing address:
  • Phone: 803-765-1919
  • Fax: 803-749-3371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number596
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: