Individual
DIANA DUBOIS ALFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
602 N MAIN ST, SUMMERVILLE, SC 29483-6627
(843) 876-2121
Mailing address
PO BOX 602108, CHARLOTTE, NC 28260-2108
(843) 792-2300
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
996
SC
363AM0700X
Medical Physician Assistant
996
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0315PA
—
SC
01
—
GP4999
MEDICAID GROUP
SC
01
—
P00851397
RR MEDICARE PTAN
SC
Enumeration date
07/18/2005
Last updated
05/11/2016
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