Provider Demographics
NPI:1770312969
Name:PANTAZIS, AMELIA
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:PANTAZIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 PLANTERS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-2431
Mailing Address - Country:US
Mailing Address - Phone:803-207-9174
Mailing Address - Fax:
Practice Address - Street 1:709 PLANTERS DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-2431
Practice Address - Country:US
Practice Address - Phone:803-207-9174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program