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General NPI Number Information
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NPI Number | 1841636016
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Entity Type | Individual
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Provider Name | TERRI BAMONTE
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Gender | Female
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Dates
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Enumeration Date | 05/15/2013
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Last Update Date | 05/15/2013
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Provider Practice Location Address
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Address Line | 6706 NURSERY RD
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City | COLUMBIA
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State | SC
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Zip | 29212-2020
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Country | US
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Telephone | 803-476-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 222 WHITTINGTON CT
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City | COLUMBIA
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State | SC
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Zip | 29210-3833
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Country | US
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Telephone | 803-772-8255
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 311
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License Number State | SC
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