MEDICARE: CHARMAINE MCKINLEY

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	1744P3200X	Prosthetics Case Management	89821	SC

General Provider Information

NPI Number	:	1851993752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARMAINE MCKINLEY

Provider Business Mailing Address
First Line	:	115 VERMILLION DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-3342
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	919 TRUE ST STE B5
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-1662
Country	:	US
Telephone Number	:	803-665-0361
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2020
Last Update Date	:	11/15/2020

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Directions to “ CHARMAINE MCKINLEY ” Practice Location

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