Individual
MISS JODY D ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4500 8TH DIVISION RD, COLUMBIA, SC 29207-5700
(803) 751-2160
Mailing address
4500 8TH DIVISION RD, COLUMBIA, SC 29207-5700
(803) 751-2160
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20390
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FQC030
—
SC
05
—
FQC043
—
SC
Enumeration date
05/11/2006
Last updated
06/20/2025
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