Individual
PRIMA DOROTHY RAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
109 BARTON CREEK CT, COLUMBIA, SC 29229-8027
(803) 256-2286
(803) 419-8430
Mailing address
109 BARTON CREEK CT, COLUMBIA, SC 29229-8027
(803) 256-2286
(803) 419-8430
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
TL3224
SC
363AM0700X
Medical Physician Assistant
Primary
3224
SC
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3224
PA LICENSE
SC
Enumeration date
05/16/2019
Last updated
07/17/2023
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