Healthcare Provider Details

I. General information

NPI: 1477749620
Provider Name (Legal Business Name): PAYAM YOUSEFIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5224 SUNSET BLVD
LEXINGTON SC
29072-9259
US

IV. Provider business mailing address

PO BOX 749306
ATLANTA GA
30374-9306
US

V. Phone/Fax

Practice location:
  • Phone: 803-796-4251
  • Fax: 803-796-4449
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32197
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: