Organization
SANDRIDGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS CYVONNE M JOHNSON (OWNER)
(803) 315-8334
Entity
Organization
Contact information
Practice address
5115 BURKE AVENUE, COLUMBIA, SC 29204
(803) 315-8334
Mailing address
5115 BURKE AVENUE, COLUMBIA, SC 29204
(803) 315-8334
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
SC
Other
Enumeration date
05/04/2007
Last updated
08/22/2020
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