Healthcare Provider Details

I. General information

NPI: 1407322167
Provider Name (Legal Business Name): MEGAN KIRKLAND BETTIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN ANNETTE KIRKLAND

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PALMETTO HEALTH PKWY STE 200
COLUMBIA SC
29212-1762
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-296-7846
  • Fax:
Mailing address:
  • Phone: 803-549-0221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3265
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: