Healthcare Provider Details

I. General information

NPI: 1861798845
Provider Name (Legal Business Name): ELIZABETH WAGONER KNIGHT N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 07/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 MONTICELLO RD
COLUMBIA SC
29203-4156
US

IV. Provider business mailing address

4605 MONTICELLO RD
COLUMBIA SC
29203-4156
US

V. Phone/Fax

Practice location:
  • Phone: 803-754-0151
  • Fax: 803-691-1778
Mailing address:
  • Phone: 803-754-0151
  • Fax: 803-691-1778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4446
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: