Healthcare Provider Details

I. General information

NPI: 1952148231
Provider Name (Legal Business Name): ALEXIA CORNELIUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXIA SHAMAEI ZADEH MD

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL PARK RD STE 402
COLUMBIA SC
29203-6839
US

IV. Provider business mailing address

216 LOSKIN LN
LEXINGTON SC
29073-7156
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-4153
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberLL97060
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: