Provider Demographics
NPI:1952742942
Name:EVERALL, ULYESSE C III (NP)
Entity Type:Individual
Prefix:
First Name:ULYESSE
Middle Name:C
Last Name:EVERALL
Suffix:III
Gender:M
Credentials:NP
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Mailing Address - Street 1:1624 MAIN STREET AGAPE SENIOR PRIMARY CARE, INC.,
Mailing Address - Street 2:DBA AGAPE PHYSICIANS CARE
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:803-454-0365
Mailing Address - Fax:803-404-6000
Practice Address - Street 1:1317 EBENEZER RD
Practice Address - Street 2:AGAPE PHYSICIANS CARE
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2336
Practice Address - Country:US
Practice Address - Phone:803-207-8200
Practice Address - Fax:803-207-8130
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2014-09-02
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Provider Licenses
StateLicense IDTaxonomies
SCAPRN18357363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner