Healthcare Provider Details

I. General information

NPI: 1376582858
Provider Name (Legal Business Name): TONYA M FARLESS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 DORCHESTER RD STE 100
CHARLESTON SC
29405-7501
US

IV. Provider business mailing address

1818 HENDERSON ST
COLUMBIA SC
29201-2619
US

V. Phone/Fax

Practice location:
  • Phone: 843-554-6737
  • Fax:
Mailing address:
  • Phone: 803-758-2600
  • Fax: 803-726-3141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1072
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: