# ENVISION WELLNESS MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043832157
- **Authorized official:** AYANNA SWINTON JAMISON MD (DR/OWNER)
- **Authorized official phone:** (803) 256-0101

## Contact information

- **Practice address:** 4100 N MAIN ST STE 101, COLUMBIA, SC 29203-5800
- **Practice address phone:** (803) 256-0101
- **Practice address fax:** (800) 854-3497
- **Mailing address:** 4100 N MAIN ST STE 101, COLUMBIA, SC 29203-5800
- **Mailing address phone:** (803) 256-0101
- **Mailing address fax:** (800) 854-3497

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/12/2020
- **Last updated:** 05/12/2020