Provider Demographics
NPI:1619345428
Name:WELNICK, GEORGIA (RN)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:WELNICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 LESLIE LOCH LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-8630
Mailing Address - Country:US
Mailing Address - Phone:803-917-3674
Mailing Address - Fax:
Practice Address - Street 1:126 LESLIE LOCH LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-8630
Practice Address - Country:US
Practice Address - Phone:803-917-3674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC61926163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health