Healthcare Provider Details

I. General information

NPI: 1811578552
Provider Name (Legal Business Name): LIBBY ALEXANDRIA LIGON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E GREENVILLE ST STE 3700
ANDERSON SC
29621-1725
US

IV. Provider business mailing address

PO BOX 100174
COLUMBIA SC
29202-3174
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-1475
  • Fax:
Mailing address:
  • Phone: 864-512-1475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number74600
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number74600
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number91891
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: