Healthcare Provider Details

I. General information

NPI: 1952051690
Provider Name (Legal Business Name): NICHOLAS WHITMORE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RICHLAND MEDICAL PARK DR STE 300
COLUMBIA SC
29203-6831
US

IV. Provider business mailing address

1 RICHLAND MEDICAL PARK DR STE 300
COLUMBIA SC
29203-6831
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-9175
  • Fax:
Mailing address:
  • Phone: 803-434-9175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberLL96840
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: