Healthcare Provider Details

I. General information

NPI: 1720991706
Provider Name (Legal Business Name): MADELINE GRAHAM ANDREWS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E MEDICAL LN STE 100&200
WEST COLUMBIA SC
29169-4847
US

IV. Provider business mailing address

6311 GARNERS FERRY RD
COLUMBIA SC
29209-1445
US

V. Phone/Fax

Practice location:
  • Phone: 803-935-8410
  • Fax: 803-936-7816
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6517
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: