Organization
WELLSPRING HEALTHCARE LLC
Active
Other names
Wellspring Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
JOSNELDAVMATUS FAIIVAE MD (DIRECTOR)
(803) 760-3306
Entity
Organization
Contact information
Practice address
1415 BLANDING ST STE 4, COLUMBIA, SC 29201-2922
(803) 779-7500
Mailing address
PO BOX 25271, COLUMBIA, SC 29224-5271
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
34709
SC
2084P0804X
Child & Adolescent Psychiatry Physician
34709
SC
2084P0805X
Geriatric Psychiatry Physician
34709
SC
Other
Enumeration date
05/15/2018
Last updated
05/15/2018
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