Individual
STACEY MICHELLE HUMPHREYS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
9 RICHLAND MEDICAL PARK DR, STE 530, COLUMBIA, SC 29203
(803) 434-4603
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
23402
WV
208000000X
Pediatrics Physician
37377
SC
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
37377
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
373777
—
SC
Enumeration date
06/25/2007
Last updated
05/20/2019
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