Healthcare Provider Details

I. General information

NPI: 1205020237
Provider Name (Legal Business Name): DORWOAH COUNTS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2007
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 N MAIN ST STE 203
COLUMBIA SC
29203-5800
US

IV. Provider business mailing address

4100 N MAIN ST STE 203
COLUMBIA SC
29203-5800
US

V. Phone/Fax

Practice location:
  • Phone: 803-754-0006
  • Fax: 803-735-1635
Mailing address:
  • Phone: 803-754-0006
  • Fax: 803-735-1635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number3252
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3252
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: