Individual
MRS. AMY MARIE ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3209 COLONIAL DR, COLUMBIA, SC 29203-6930
(803) 434-6113
(803) 434-4277
Mailing address
3555 HARDEN STREET EXT, 15 MEDICAL PARK, COLUMBIA, SC 29203-6894
(803) 545-5017
(803) 255-3451
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
103939
NC
363A00000X
Physician Assistant
2373
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2288PA
—
SC
05
—
8901642
—
NC
Enumeration date
11/13/2006
Last updated
12/03/2015
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