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General NPI Number Information
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NPI Number | 1285491225
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Entity Type | Organization
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Legal Business Name | VIZER WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 03/05/2024
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 7356 GARNERS FERRY RD STE 128
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City | COLUMBIA
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State | SC
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Zip | 29209-2146
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Country | US
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Telephone | 803-580-4747
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 141
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City | SUMTER
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State | SC
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Zip | 29151-0141
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Country | US
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Telephone | 803-580-4747
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLY DIANNE BILLIE JACKSON
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Credential | APRN
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Telephone | 803-580-4747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LC1500X
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Taxonomy Name | Community Health Nurse Practitioner
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License Number |
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License Number State |
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