Healthcare Provider Details

I. General information

NPI: 1447114749
Provider Name (Legal Business Name): MICHELLE ANNICCHIARICO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6595 JOHNSON RD
GEORGETOWN SC
29440-1902
US

IV. Provider business mailing address

6595 JOHNSON RD
GEORGETOWN SC
29440-1902
US

V. Phone/Fax

Practice location:
  • Phone: 843-240-6392
  • Fax:
Mailing address:
  • Phone: 843-240-6392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: