Healthcare Provider Details

I. General information

NPI: 1225458870
Provider Name (Legal Business Name): ELIZA JACOB APPLEBY D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZA ANILA JACOB DO

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 SALUDA POINTE DR
LEXINGTON SC
29072-7295
US

IV. Provider business mailing address

PO BOX 6069
WEST COLUMBIA SC
29171-6069
US

V. Phone/Fax

Practice location:
  • Phone: 803-785-3590
  • Fax:
Mailing address:
  • Phone: 803-935-8292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0102205276
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number80030
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number87728
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: