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General NPI Number Information
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NPI Number | 1407873086
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Entity Type | Individual
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Provider Name | ELIZABETH HARRISON CONYERS PAC
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 111 MIRACLE DR
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City | AIKEN
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State | SC
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Zip | 29801-6351
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Country | US
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Telephone | 803-641-7850
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Fax |
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Provider Business Mailing Address
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Address Line | 116 ILEX LN
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City | AIKEN
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State | SC
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Zip | 29803-8227
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Country | US
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Telephone | 903-245-5353
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 002475
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA1654
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3964
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License Number State | SC
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