Healthcare Provider Details

I. General information

NPI: 1912835356
Provider Name (Legal Business Name): MS. JAMES ANDERSON II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 EAGLESTON DR
MONCKS CORNER SC
29461-3756
US

IV. Provider business mailing address

312 EAGLESTON DR
MONCKS CORNER SC
29461-3756
US

V. Phone/Fax

Practice location:
  • Phone: 843-925-1059
  • Fax:
Mailing address:
  • Phone: 843-925-1059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberSC014744
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: