Organization
MIDLANDS PEDIATRICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLARENCE JOSEPH DOLLISON JR. MD (PRESIDENT)
(803) 254-4257
Entity
Organization
Contact information
Practice address
2712 MIDDLEBURG DRIVE, SUITE #101, COLUMBIA, SC 29204-2415
(803) 254-4257
(803) 252-7334
Mailing address
2712 MIDDLEBURG DRIVE, SUITE #101, COLUMBIA, SC 29204-2415
(803) 254-4257
(803) 252-7334
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP 3475
—
SC
Enumeration date
12/14/2006
Last updated
09/23/2011
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