Healthcare Provider Details

I. General information

NPI: 1841853074
Provider Name (Legal Business Name): MARTHA T LEMMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARTHA TIBEBU LEMMA

II. Dates (important events)

Enumeration Date: 04/14/2019
Last Update Date: 09/29/2026
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 RICHLAND MEDICAL PARK DR STE 320
COLUMBIA SC
29203-6896
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-6771
  • Fax: 803-434-3955
Mailing address:
  • Phone: 864-695-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number87708
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number87708
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: