Healthcare Provider Details

I. General information

NPI: 1508507807
Provider Name (Legal Business Name): ABDULLAH A BAOSMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2022
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 SUNSET BLVD
WEST COLUMBIA SC
29169-4810
US

IV. Provider business mailing address

1230 BAXTER ST
ATHENS GA
30606-3712
US

V. Phone/Fax

Practice location:
  • Phone: 803-936-7372
  • Fax:
Mailing address:
  • Phone: 706-389-3860
  • Fax: 706-389-3861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number13701
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number94693
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: