Provider Demographics
NPI:1710776935
Name:COVER, VIOLET
Entity type:Individual
Prefix:
First Name:VIOLET
Middle Name:
Last Name:COVER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 SILO RD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-8334
Mailing Address - Country:US
Mailing Address - Phone:803-919-6054
Mailing Address - Fax:
Practice Address - Street 1:5210 SILO RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-8334
Practice Address - Country:US
Practice Address - Phone:803-919-6054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC011450263172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver