Healthcare Provider Details

I. General information

NPI: 1336348911
Provider Name (Legal Business Name): DORN VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/13/2007
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

702 WHITEWATER DR
IRMO SC
29063-7809
US

V. Phone/Fax

Practice location:
  • Phone: 803-776-4000
  • Fax:
Mailing address:
  • Phone: 803-730-2463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number5616
License Number StateSC

VIII. Authorized Official

Name: MRS. CAROLYN GOLSON
Title or Position: SOCIAL WORKER
Credential:
Phone: 803-776-4000