MEDICARE: ILLUMINATION PSYCHIATRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1780499830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILLUMINATION PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	115 OAKHURST DR
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29860-9723
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 OAKHURST DR
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29860-9723
Country	:	US
Telephone Number	:	802-532-3355
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SARAH MCNAIR
Credential	:	MD
Telephone Number	:	802-532-3355

Provider Enumeration Date	:	02/07/2025
Last Update Date	:	02/07/2025

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