Healthcare Provider Details

I. General information

NPI: 1285408724
Provider Name (Legal Business Name): MALIK MCGILL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 FOREST DR
FOREST ACRES SC
29206
US

IV. Provider business mailing address

527 KIMPTON DR
COLUMBIA SC
29223-4273
US

V. Phone/Fax

Practice location:
  • Phone: 803-376-9789
  • Fax:
Mailing address:
  • Phone: 843-430-0284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12130
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: