Healthcare Provider Details

I. General information

NPI: 1932601903
Provider Name (Legal Business Name): JAMIE ANDREWS SUSSMAN ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 FINLEY RD
COLUMBIA SC
29203-9275
US

IV. Provider business mailing address

91 FINLEY RD
COLUMBIA SC
29203-9275
US

V. Phone/Fax

Practice location:
  • Phone: 803-691-5720
  • Fax:
Mailing address:
  • Phone: 803-691-5720
  • Fax: 803-726-6112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number21622
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: