Individual ProviderAmanda CharltonNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address11 Gateway Corners Park, Columbia, SC 29203(803) 462-2300PECOS EnrollmentBased on the most recent information from CMS, provider Amanda Charlton is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1245592526Provider TypeIndividualFull NameCharlton, AmandaCredentialNPGenderFemaleSole ProprietorNoEnumeration Date6/12/2012Last Updated7/29/2025Contact InformationPractice LocationPractice Address11 Gateway Corners Park, Columbia, SC 29203Phone(803) 462-2300Fax(803) 462-0375Mailing LocationMailing Address11 Gateway Corners Park, Columbia, SC 29203Phone(803) 462-2300Fax(803) 462-0375Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense17840South CarolinaProvider IdentifiersIDDescriptionIssuerID12469613DescriptionOtherIssuerCAQH PROVIDER IDSouth CarolinaIDNP2176DescriptionMedicaidIssuerUnlistedSouth Carolina