Individual
ELIZABETH DERKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9 RICHLAND MEDICAL PARK DR STE 110, COLUMBIA, SC 29203-6859
(803) 434-2505
(803) 434-2181
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1519
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1519
LICENSED DIETITIAN
SC
05
—
DT1101
—
SC
Enumeration date
08/28/2016
Last updated
03/23/2018
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