Healthcare Provider Details

I. General information

NPI: 1528103678
Provider Name (Legal Business Name): ELIZABETH ANDERSON DICKINSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

964 LOCHEND DR
DARLINGTON SC
29532-5698
US

IV. Provider business mailing address

PO BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 843-777-6890
  • Fax: 843-777-6891
Mailing address:
  • Phone: 843-777-6870
  • Fax: 843-777-6871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12821
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number12821
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: