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General NPI Number Information
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NPI Number | 1336348911
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Entity Type | Organization
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Legal Business Name | DORN VAMC
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 07/13/2007
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Provider Practice Location Address
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Address Line | 6439 GARNERS FERRY RD
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City | COLUMBIA
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State | SC
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Zip | 29209-1638
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Country | US
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Telephone | 803-776-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 702 WHITEWATER DR
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City | IRMO
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State | SC
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Zip | 29063-7809
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Country | US
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Telephone | 803-730-2463
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MRS. CAROLYN GOLSON
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Credential |
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Telephone | 803-776-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | 5616
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License Number State | SC
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