Healthcare Provider Details

I. General information

NPI: 1245592526
Provider Name (Legal Business Name): AMANDA CHARLTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 E HOSPITAL DR STE 400
WEST COLUMBIA SC
29169-4800
US

IV. Provider business mailing address

PO BOX 6069
WEST COLUMBIA SC
29171-6069
US

V. Phone/Fax

Practice location:
  • Phone: 803-936-3300
  • Fax: 803-936-7735
Mailing address:
  • Phone: 803-936-3300
  • Fax: 803-936-7735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17840
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: