Healthcare Provider Details

I. General information

NPI: 1548199342
Provider Name (Legal Business Name): TAMYKA SACHIA MALCOLM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 FALLEN LEAF DR
COLUMBIA SC
29229-9430
US

IV. Provider business mailing address

210 FALLEN LEAF DR
COLUMBIA SC
29229-9430
US

V. Phone/Fax

Practice location:
  • Phone: 704-740-0045
  • Fax:
Mailing address:
  • Phone: 704-740-0045
  • Fax: 704-740-0045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: