Healthcare Provider Details

I. General information

NPI: 1356390355
Provider Name (Legal Business Name): WILLIAM JENNINGS BRYAN DORN VETERANS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6439 GARNERS FERRY RD
COLUMBIA SC
29209-1638
US

IV. Provider business mailing address

59 LOGGERHEAD DR
COLUMBIA SC
29229-7911
US

V. Phone/Fax

Practice location:
  • Phone: 803-776-4000
  • Fax:
Mailing address:
  • Phone: 803-699-9887
  • Fax: 803-699-9887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number1377
License Number StateFL

VIII. Authorized Official

Name: DR. B. M. REDDY
Title or Position: PM&RS CHIEF
Credential: M.D.
Phone: 803-776-4000