Healthcare Provider Details

I. General information

NPI: 1346498185
Provider Name (Legal Business Name): ASHLEY ELIZABETH DYSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ASHLEY ELIZABETH COX

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2117 GERVAIS STREET WAVERLY FAMILY PRACTICE
COLUMBIA SC
29204
US

IV. Provider business mailing address

148 RIVERVALLEY DRIVE
COLUMBIA SC
29201
US

V. Phone/Fax

Practice location:
  • Phone: 803-748-1181
  • Fax: 803-748-1185
Mailing address:
  • Phone: 803-270-2676
  • Fax: 434-947-5971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110002853
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: