Healthcare Provider Details

I. General information

NPI: 1871203810
Provider Name (Legal Business Name): DIANA DENNISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5460 HIGHMARKET ST
GEORGETOWN SC
29440-9764
US

IV. Provider business mailing address

5460 HIGHMARKET ST
GEORGETOWN SC
29440-9764
US

V. Phone/Fax

Practice location:
  • Phone: 843-304-5883
  • Fax:
Mailing address:
  • Phone: 843-304-5883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number007880024
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number007880024
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number007880024
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number007880024
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number121624
License Number StateSC
# 6
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number007880024
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: