Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 22445 | SC |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 22445 | SC |
NPI | 1164995346 |
---|---|
Provider Name | Rachelle Shepard |
First Address | Columbia, SC 29229-8500 |
Second Address | Columbia, SC 29229-8500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2019 |
Last Update Date | 28/09/2020 |