# MIDLANDS PEDIATRICS PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356403612
- **Authorized official:** MR. CLARENCE JOSEPH DOLLISON JR. MD (PRESIDENT)
- **Authorized official phone:** (803) 254-4257

## Contact information

- **Practice address:** 2712 MIDDLEBURG DRIVE, SUITE \#101, COLUMBIA, SC 29204-2415
- **Practice address phone:** (803) 254-4257
- **Practice address fax:** (803) 252-7334
- **Mailing address:** 2712 MIDDLEBURG DRIVE, SUITE \#101, COLUMBIA, SC 29204-2415
- **Mailing address phone:** (803) 254-4257
- **Mailing address fax:** (803) 252-7334

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | — | NULL | Yes |
| 208000000X | Pediatrics Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/14/2006
- **Last updated:** 09/23/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GP 3475 | — | SC |