| Envision Wellness Medical Group Llc | |
|
4100 N Main St Ste 101 Columbia SC 29203-5800 | |
| (803) 256-0101 | |
| (800) 854-3497 |
| Full Name | Envision Wellness Medical Group Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4100 N Main St Ste 101, Columbia, South Carolina |
| Authorized Official Name and Position | Ayanna Swinton Jamison (DR/OWNER) |
| Authorized Official Contact | 8032560101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Envision Wellness Medical Group Llc 4100 N Main St Ste 101 Columbia SC 29203-5800 Ph: (803) 256-0101 | Envision Wellness Medical Group Llc 4100 N Main St Ste 101 Columbia SC 29203-5800 Ph: (803) 256-0101 |
| NPI Number | 1043832157 |
|---|---|
| Provider Enumeration Date | 05/12/2020 |
| Last Update Date | 05/12/2020 |
| Certification Date | 05/12/2020 |
| Medicare PECOS PAC ID | 1456744374 |
|---|---|
| Medicare Enrollment ID | O20220216002183 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043832157 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Ayanna Swinton Jamison |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053359851 PECOS PAC ID: 2163445735 Enrollment ID: I20060110000298 |
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