Individual
ANNA ILIASOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
400 PALMETTO HEALTH PKWY, COLUMBIA, SC 29212-1760
(803) 907-7000
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
22826
SC
Other
Enumeration date
07/11/2019
Last updated
07/15/2019
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