Healthcare Provider Details

I. General information

NPI: 1700749298
Provider Name (Legal Business Name): BRIANA FALLON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 HENDERSON ST STE C
COLUMBIA SC
29201-2648
US

IV. Provider business mailing address

7 FENWICK CT
COLUMBIA SC
29223-8250
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-5591
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: