Individual
DR. DONNA GRIMSLEY MIZELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
25 EAST CLARK STREET, PINEWOOD, SC 29125
(803) 774-4500
(803) 452-5712
Mailing address
25 EAST CLARK STREET, PINEWOOD, SC 29125
(803) 774-4500
(803) 452-5712
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
200300669
NC
207Q00000X
Family Medicine Physician
Primary
22449
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89135JN
—
NC
05
—
L36646
—
SC
Enumeration date
06/17/2006
Last updated
10/25/2022
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