Healthcare Provider Details

I. General information

NPI: 1104481258
Provider Name (Legal Business Name): RACHEL ETHRIDGE GARRETT CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL LAUREN ETHRIDGE

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 BREWERS OAK LN
WEST COLUMBIA SC
29169-3374
US

IV. Provider business mailing address

144 BREWERS OAK LN
WEST COLUMBIA SC
29169-3374
US

V. Phone/Fax

Practice location:
  • Phone: 864-580-3789
  • Fax:
Mailing address:
  • Phone: 864-580-3789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: