MALISSA WILSON ETHEREDGE (NPI# 1811301203) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811301203 |
| Entity Type | Individual |
| Full Name | MALISSA WILSON ETHEREDGE |
| Other Name | MALISSA BLAIR WILSON |
| Credential | M.D. |
| Practice Address |
100 Palmetto Health Pkwy Ste G100 Columbia SC 29212-1754 |
| Mailing Address |
Po Box 743904 Atlanta GA 30374-3904 |
| Practice Telephone | 8034341210 |
| Practice Fax Number | 8034341212 |
| Mailing Telephone | 8032967320 |
| Mailing Fax Number | 8032967330 |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2018-12-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 37102 | SC | Allopathic & Osteopathic Physicians |
| N | 207R00000X | Internal Medicine | LL37102 | SC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | 371029 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1801 Sunset Drive, Internal Medicine Clinic, Columbia, SC 29203 | 8034344153 | 8034344160 |
| Street Address |
100 PALMETTO HEALTH PKWY STE G100 |
| City | COLUMBIA |
| State | SC |
| Zip Code | 29212-1754 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245758887 | Amanda Gail Holloman | Pharmacist | 6021 St. Andrews Road, Columbia, SC 29212 | 2017-09-04 |
| 1578080180 | Alvin Mitchell Jr. | Non-emergency Medical Transport (VAN) | 10 Breezewood Court, Columbia, SC 29212 | 2017-08-24 |
| 1467975102 | Shelby Clemmer | Behavior Technician | 2 Harbison Way, Columbia, SC 29212 | 2017-07-25 |
| 1982149019 | Showntellem | Private Vehicle | 336 Foxfire Dr, Columbia, SC 29212 | 2016-12-28 |
| 1902215296 | Miranda Willis Adult Day Care, LLC | Social Worker | 5932 Mcmillian Circle, Columbia, SC 29212 | 2014-08-12 |
| 1013342591 | Robert Glendon Long | Pediatrics | 15 Woodpine Ct, Columbia, SC 29212 | 2013-09-04 |
| 1174969638 | Melinda Dumas Crenshaw | Psychologist | 2800 Ashland Rd., Columbia, SC 29212 | 2013-05-10 |
| 1417209982 | Physician Services LLC | Internal Medicine | 214 Lake Front Drive, Physician Services, Cola, SC 29212 | 2012-10-09 |
| 1306131800 | Rocky Mountain Holdings LLC | Ambulance | 6015 Saint Andrews Rd, Columbia, SC 29212 | 2011-06-13 |
| 1023262839 | Candace Anne Aguiar | Nurse Anesthetist, Certified Registered | 400 Palmetto Health Pkwy, Palmetto Health Baptist Parkridge, Columbia, SC 29212 | 2008-11-06 |
| Find all providers in zip 29212 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740808815 | Thai Quoc Nguyen | Internal Medicine | University Hospital Ma421 Med Sciences Bldg, Columbia, MO 65212-0001 | 2020-07-06 |
| 1649898784 | Peter Egwom | Internal Medicine | University Hospital One Hospital Drive Dc.043.00, Columbia, MO 65212-0001 | 2020-07-06 |
| 1790302362 | Klariz Teves Tucker | Internal Medicine | Internal Medcine Center, 1801 Sunset Drive, Columbia, SC 29203 | 2020-06-30 |
| 1851918346 | Maxwell Isaac | Internal Medicine | University Hospital 1 Hospital Drive Dc 043.00, Columbia, MO 65212-0001 | 2020-06-30 |
| 1285251983 | Shannon Ejiofor | Internal Medicine | University Hospital One Hospital Drive Dc043.00, Columbia, MO 65212-0001 | 2020-06-29 |
| 1336766278 | Jordan Stauffer | Internal Medicine | University Hospital One Hospital Dr, Columbia, MO 65212-0001 | 2020-06-26 |
| 1972120814 | Pak Ho Au | Internal Medicine | University Hospital One Hospital Dr Dc043.00, Columbia, MO 65212-0001 | 2020-06-26 |
| 1700402849 | Michael Allan Goble | Internal Medicine | Internal Medical Center, 1801 Sunset Drive, Columbia, SC 29203 | 2020-06-24 |
| 1740806389 | Alan Verl Godfrey | Internal Medicine | University of Missouri Hospital 1 Hospital Dr, Columbia, MO 65212-0001 | 2020-06-19 |
| 1003432642 | Gregory Gaskey | Internal Medicine | University of Missouri Hospital One Hospital Drive, Columbia, MO 65212-0001 | 2020-06-19 |
| Find all providers in COLUMBIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.