Healthcare Provider Details

I. General information

NPI: 1184812281
Provider Name (Legal Business Name): VIRGINIA M CORLEY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 ALICE DR STE F
SUMTER SC
29150-1941
US

IV. Provider business mailing address

1116 ALICE DR STE F
SUMTER SC
29150-1941
US

V. Phone/Fax

Practice location:
  • Phone: 803-469-7770
  • Fax: 803-469-7701
Mailing address:
  • Phone: 803-469-7770
  • Fax: 803-469-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0377
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: