Healthcare Provider Details

I. General information

NPI: 1912864224
Provider Name (Legal Business Name): DIONA LEAK CMF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 HIGHMARKET ST
GEORGETOWN SC
29440-3121
US

IV. Provider business mailing address

1768 CALHOUN DR
GEORGETOWN SC
29440-6522
US

V. Phone/Fax

Practice location:
  • Phone: 843-359-2533
  • Fax:
Mailing address:
  • Phone: 843-359-2533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License NumberC54115
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: