Healthcare Provider Details

I. General information

NPI: 1588571822
Provider Name (Legal Business Name): WHITNEY MICHELLE SAMUEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W EVANS ST
FLORENCE SC
29501-3469
US

IV. Provider business mailing address

218 BYRD LN
FLORENCE SC
29506-6307
US

V. Phone/Fax

Practice location:
  • Phone: 800-368-7551
  • Fax:
Mailing address:
  • Phone: 843-616-8939
  • Fax:

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 StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: