Healthcare Provider Details

I. General information

NPI: 1992636112
Provider Name (Legal Business Name): ELLEN PARRIS BOATWRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 FAIRVIEW FARMS DR
LANDRUM SC
29356-9109
US

IV. Provider business mailing address

190 FAIRVIEW FARMS DR
LANDRUM SC
29356-9109
US

V. Phone/Fax

Practice location:
  • Phone: 864-457-6499
  • Fax:
Mailing address:
  • Phone: 864-457-6499
  • 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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: