Individual
ETHAN LAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
114 GATEWAY CORPORATE BLVD STE 210, COLUMBIA, SC 29203-9785
(803) 365-8640
Mailing address
5 MOUNTAIN ROSE CT, SIMPSONVILLE, SC 29681-4869
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
02/13/2024
Last updated
12/15/2025
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