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General NPI Number Information
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NPI Number | 1952622326
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Entity Type | Organization
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Legal Business Name | SOUTHERN UROGYNECOLOGY LLC
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Dates
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Enumeration Date | 06/19/2010
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 115 MIDLANDS CT
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-3456
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Country | US
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Telephone | 803-732-0738
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Fax |
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Provider Business Mailing Address
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Address Line | 115 MIDLANDS CT
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-3456
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Country | US
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Telephone | 803-732-0738
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREA M PEZZELLA
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Credential | M.D.
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Telephone | 803-732-0738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 29701
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License Number State | SC
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