1528151255 NPI number — CAROLYN ANN KNIGHT-SCHLONDROP NP

Table of content: CAROLYN ANN KNIGHT-SCHLONDROP NP (NPI 1528151255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528151255 NPI number — CAROLYN ANN KNIGHT-SCHLONDROP NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNIGHT-SCHLONDROP
Provider First Name:
CAROLYN
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAGLAND
Provider Other First Name:
CAROLYN
Provider Other Middle Name:
KNIGHT
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528151255
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6326 SAINT ANDREWS RD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29212-3126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-979-9666
Provider Business Mailing Address Fax Number:
800-878-6608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6326 SAINT ANDREWS RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29212-3126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-979-9666
Provider Business Practice Location Address Fax Number:
800-878-6608
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  03004 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AA22619610 . This is a "MEDICARE SC PTAN 9610" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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