Individual
MRS. TONYA M FARLESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4115 DORCHESTER RD STE 100, CHARLESTON, SC 29405-7501
(843) 554-6737
Mailing address
1818 HENDERSON ST, COLUMBIA, SC 29201-2619
(803) 758-2600
(803) 726-3141
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1072
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0391PA
—
SC
01
—
1069402
NCCPA
SC
01
—
AA1344A634
MEDICARE PTAN
SC
Enumeration date
06/06/2006
Last updated
02/09/2026
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