Provider Demographics
NPI:1437446382
Name:SANDHILLS OBGYN ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:SANDHILLS OBGYN ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:NWANAGU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-960-6133
Mailing Address - Street 1:PO BOX 7481
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-7481
Mailing Address - Country:US
Mailing Address - Phone:803-960-6133
Mailing Address - Fax:
Practice Address - Street 1:1301 TAYLOR ST
Practice Address - Street 2:SUITE 2-I
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2942
Practice Address - Country:US
Practice Address - Phone:803-960-6133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21430207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT55936Medicaid
SCG00211Medicare UPIN