Individual
EMMELINE SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14 RICHLAND MEDICAL PARK DR STE 320, COLUMBIA, SC 29203-6896
(803) 434-6771
(803) 434-3955
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
19681
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP3376
—
SC
Enumeration date
08/11/2015
Last updated
04/27/2021
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