Healthcare Provider Details

I. General information

NPI: 1134520836
Provider Name (Legal Business Name): MORGAN KANWISHER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 TAYLOR ST SUITE 6F
COLUMBIA SC
29201-2923
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-939-0174
  • Fax: 803-217-0282
Mailing address:
  • Phone: 803-296-7320
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19121
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: