Healthcare Provider Details

I. General information

NPI: 1639926595
Provider Name (Legal Business Name): MARTHA HUTCHINSON BUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTHA JOANNE HUTCHINSON

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 RICHLAND MEDICAL PARK DR STE 350
COLUMBIA SC
29203-6896
US

IV. Provider business mailing address

300 E MCBEE AVE STE 300
GREENVILLE SC
29601-2899
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-1663
  • Fax: 803-434-7092
Mailing address:
  • Phone: 864-695-6734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28975
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number230483
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number95254531
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28975
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: