Healthcare Provider Details

I. General information

NPI: 1629750740
Provider Name (Legal Business Name): JANELL MCALLISTER CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 FORUM DR STE 4
COLUMBIA SC
29229-7980
US

IV. Provider business mailing address

620 SUMMERALL LN
COLUMBIA SC
29229-6809
US

V. Phone/Fax

Practice location:
  • Phone: 803-906-2524
  • Fax: 803-906-2523
Mailing address:
  • Phone: 803-915-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberG8N3B7Q4
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: