Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Providence Physician Practices LLC

Organization Plastic Surgery Physician · NPI 1689034548

Providence Physician Practices LLC is a Plastic Surgery Physician in Columbia, South Carolina. Registered with an NPI since 2016.

In the registry since
2016
Specialties on file
3
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1655 Bernardin Ave Ste 110
Columbia, SC 29204-2039
Phone: (803) 409-7130
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgery Physician (primary) Taxonomy 208600000X
Plastic Surgery Physician Taxonomy 208200000X
Plastic and Reconstructive Surgery Physician Taxonomy 2086S0122X

Record details

NPI number1689034548
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jess Judy — President · (615) 920-7000
Other names Providence Surgical Associates
NPI enumeratedMarch 4, 2016
Last updated in NPPESFebruary 22, 2017
Mailing address114 Gateway Corporate Blvd, Ste 425, Columbia, SC 29203-9740

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