Healthcare Provider Details

I. General information

NPI: 1164518494
Provider Name (Legal Business Name): ELOISE J. PRIJOLES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 THURMOND MALL
COLUMBIA SC
29201-2375
US

IV. Provider business mailing address

101 GREGOR MENDEL CIR
GREENWOOD SC
29646-2316
US

V. Phone/Fax

Practice location:
  • Phone: 803-799-5390
  • Fax:
Mailing address:
  • Phone: 864-941-8100
  • Fax: 864-388-1052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberMD23944
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: