Healthcare Provider Details

I. General information

NPI: 1861961997
Provider Name (Legal Business Name): BAILEY ELIZABETH LIMYANSKY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BAILEY ELIZABETH ERNSTES

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 RICHLAND MEDICAL PARK DR STE 350
COLUMBIA SC
29203-6896
US

IV. Provider business mailing address

14 RICHLAND MEDICAL PARK DR STE 350
COLUMBIA SC
29203-6896
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-3319
  • Fax:
Mailing address:
  • Phone: 803-434-3319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3095
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10811
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: