Healthcare Provider Details

I. General information

NPI: 1760542948
Provider Name (Legal Business Name): ALICIA LIMBAUGH TOLBERT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 COLLEGE AVE SUITE 1
CLEMSON SC
29631-1443
US

IV. Provider business mailing address

522 COLLEGE AVE SUITE 1
CLEMSON SC
29631-1443
US

V. Phone/Fax

Practice location:
  • Phone: 864-654-7841
  • Fax: 864-654-7641
Mailing address:
  • Phone: 864-654-7841
  • Fax: 864-654-7641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24081
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: