Healthcare Provider Details

I. General information

NPI: 1871408021
Provider Name (Legal Business Name): ANZY JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4822 E PALMETTO ST
FLORENCE SC
29506-4530
US

IV. Provider business mailing address

5819 HIGHWAY 712
GALIVANTS FERRY SC
29544-6337
US

V. Phone/Fax

Practice location:
  • Phone: 843-661-1362
  • Fax:
Mailing address:
  • Phone: 843-231-8888
  • 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: