Healthcare Provider Details

I. General information

NPI: 1952622326
Provider Name (Legal Business Name): SOUTHERN UROGYNECOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2010
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MIDLANDS CT
WEST COLUMBIA SC
29169-3456
US

IV. Provider business mailing address

115 MIDLANDS CT
WEST COLUMBIA SC
29169-3456
US

V. Phone/Fax

Practice location:
  • Phone: 803-732-0738
  • Fax:
Mailing address:
  • Phone: 803-732-0738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number29701
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREA M PEZZELLA
Title or Position: OWNER
Credential: M.D.
Phone: 803-732-0738