Individual
DR. MICHELLE WIDENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11 RICHLAND MEDICAL PARK DR, COLUMBIA, SC 29203-6863
(803) 434-4506
(803) 434-4852
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
247986
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
247986
—
SC
Enumeration date
09/20/2006
Last updated
11/21/2022
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