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General NPI Number Information
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NPI Number | 1356390355
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Entity Type | Organization
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Legal Business Name | WILLIAM JENNINGS BRYAN DORN VETERANS HOSPITAL
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 08/22/2020
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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 | 59 LOGGERHEAD DR
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City | COLUMBIA
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State | SC
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Zip | 29229-7911
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Country | US
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Telephone | 803-699-9887
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Fax | 803-699-9887
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Authorized Official
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Title or Position | PM&RS CHIEF
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Name | DR. B. M. REDDY
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Credential | M.D.
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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 | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 1377
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License Number State | FL
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