Healthcare Provider Details

I. General information

NPI: 1801027776
Provider Name (Legal Business Name): ANDREA FANNING ATKINS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 N 8TH AVE SUITE 3B
DILLON SC
29536-2549
US

IV. Provider business mailing address

PO BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 843-841-3825
  • Fax: 843-841-3830
Mailing address:
  • Phone: 843-841-2816
  • Fax: 843-841-2795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3963
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: