Healthcare Provider Details

I. General information

NPI: 1023933397
Provider Name (Legal Business Name): MRS. VANESSA BADGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 14 ST W
FAIRFAX SC
29827-5704
US

IV. Provider business mailing address

PO BOX 1456
FAIRFAX SC
29827-1456
US

V. Phone/Fax

Practice location:
  • Phone: 839-204-2056
  • Fax: 839-204-2030
Mailing address:
  • Phone: 839-204-2056
  • Fax: 839-204-2030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: