Provider Demographics
NPI:1649526997
Name:SANDHILLS RHEUMATOLOGY, LLC
Entity type:Organization
Organization Name:SANDHILLS RHEUMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNEETHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MORTHALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-462-2884
Mailing Address - Street 1:4611 HARD SCRABBLE RD
Mailing Address - Street 2:SUITE 359
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8584
Mailing Address - Country:US
Mailing Address - Phone:803-462-2884
Mailing Address - Fax:803-462-2883
Practice Address - Street 1:2233 CLEMSON RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8016
Practice Address - Country:US
Practice Address - Phone:803-462-2884
Practice Address - Fax:803-462-2883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28893207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC288931Medicaid
SC288931Medicaid