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General NPI Number Information
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NPI Number | 1124901459
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Entity Type | Organization
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Legal Business Name | THREE RIVERS MEDICAL ASSOCIATES, PA
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Dates
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Enumeration Date | 07/25/2025
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 115 ATRIUM WAY
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City | COLUMBIA
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State | SC
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Zip | 29223-6371
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Country | US
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Telephone | 839-200-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 7430 COLLEGE ST
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City | IRMO
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State | SC
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Zip | 29063-2903
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN GOULD
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Credential | DO
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Telephone | 839-200-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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