Provider Demographics
NPI:1790927630
Name:HYMON, MARIA GEORGE (ACNP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:GEORGE
Last Name:HYMON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:DIANE
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:114 GATEWAY CORPORATE BLVD.
Mailing Address - Street 2:SUITE - 425
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-865-4780
Mailing Address - Fax:803-865-4932
Practice Address - Street 1:1655 BERNARDIN AVENUE
Practice Address - Street 2:SUITE - 350
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204
Practice Address - Country:US
Practice Address - Phone:803-253-7575
Practice Address - Fax:803-253-7571
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3856363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1406Medicaid
SCNP1406Medicaid