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General NPI Number Information
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NPI Number | 1689878910
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Entity Type | Organization
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Legal Business Name | DORN VA MEDICAL CENTER
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Dates
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Enumeration Date | 06/12/2007
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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 | 504 GREAT NORTH RD
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City | COLUMBIA
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State | SC
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Zip | 29223-5153
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | C&P EXAMINER
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Name | MELISSA LOGAN
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Credential | MD
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Telephone | 803-629-5568
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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 | 0116018503
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License Number State | VA
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