Healthcare Provider Details

I. General information

NPI: 1932303708
Provider Name (Legal Business Name): ANNE CHRISTINA ZIMMERMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BOZARD ST
MANNING SC
29102
US

IV. Provider business mailing address

22 BOZARD ST
MANNING SC
29102-2935
US

V. Phone/Fax

Practice location:
  • Phone: 803-435-8828
  • Fax: 803-435-2239
Mailing address:
  • Phone: 803-435-8828
  • Fax: 803-435-2239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number70612
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO153324
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP60048337
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM5928
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36190
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: