Healthcare Provider Details

I. General information

NPI: 1649116252
Provider Name (Legal Business Name): MACKENZIE SPANGLER AGPC-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 LONGTOWN RD
COLUMBIA SC
29229-8550
US

IV. Provider business mailing address

PO BOX 6069
WEST COLUMBIA SC
29171-6069
US

V. Phone/Fax

Practice location:
  • Phone: 803-865-2122
  • Fax: 803-865-1464
Mailing address:
  • Phone: 803-865-2122
  • Fax: 803-865-1464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: