Healthcare Provider Details

I. General information

NPI: 1801868609
Provider Name (Legal Business Name): ELIZABETH DERRICK WOFFORD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 FOREST DR C/O PROVIDENCE HOSPITAL
COLUMBIA SC
29204-2026
US

IV. Provider business mailing address

PO BOX 30309
CHARLESTON SC
29417-0309
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-5336
  • Fax: 803-256-5454
Mailing address:
  • Phone: 843-554-9300
  • Fax: 843-556-8780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number14693
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: