Individual
DEAUNDRIA FREDRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPT
Contact information
Practice address
223 CALICO CT, WEST COLUMBIA, SC 29172-2608
(803) 383-5818
Mailing address
223 CALICO CT, WEST COLUMBIA, SC 29172-2608
(803) 383-5818
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000
N/A
—
Enumeration date
07/26/2022
Last updated
07/26/2022
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