Envision Wellness Medical Group LLC
Psychiatry & Neurology, Psychiatry in Columbia, SC. Organization (NPI-2).
NPI number1710690912
StatusActive
Last updated in NPPESJan 3, 2023
Details
- NPI
- 1710690912
- Entity type
- Organization (NPI-2)
- Legal business name
- Envision Wellness Medical Group LLC
- Organization subpart
- Yes
- Enumeration date
- Jan 3, 2023
- Certification date
- Jan 3, 2023
- Last updated
- Jan 3, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology, Psychiatry | – | – | Yes |
Other names
- Envision Wellness Medical Group Iop (Doing Business As)
Practice location
4100 N Main St Ste 101Columbia, SC 29203-5800
Phone 803-256-0101 · Fax 800-854-3497
Mailing address
4100 N Main St Ste 101Columbia, SC 29203-5800
Phone 803-256-0101 · Fax 800-854-3497
Authorized official
Lisa Roberts
Office Manager
8032560101
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