MEDICARE: ELIZABETH-CIERRA PARSON GREENE RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1979	SC

General Provider Information

NPI Number	:	1891645818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH-CIERRA PARSON GREENE RD

Provider Business Mailing Address
First Line	:	PO BOX 6069
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29171-6069
Country	:	US
Telephone Number	:	803-791-2491
Fax Number	:	803-794-5960

Provider Business Practice Location Address
First Line	:	146 E HOSPITAL DR STE 410
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-4800
Country	:	US
Telephone Number	:	803-936-3300
Fax Number	:	803-936-7735

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	02/05/2026

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