Healthcare Provider Details

I. General information

NPI: 1578293726
Provider Name (Legal Business Name): BRIANNA BUTLER RMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2022
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 SAGAMARE ROAD
COLUMBIA SC
29229
US

IV. Provider business mailing address

6729 TWO NOTCH RD SUITE M. PMB 1181
COLUMBIA SC
29223
US

V. Phone/Fax

Practice location:
  • Phone: 803-760-2816
  • Fax:
Mailing address:
  • Phone: 803-760-2816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: