Organization
GREAT DESTINY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIONA PRAYLOW MD (OWNER)
(803) 394-1308
Entity
Organization
Contact information
Practice address
605 ALCOTT DR, COLUMBIA, SC 29203-4411
(803) 573-2228
Mailing address
5 POCOSIN CT, ELGIN, SC 29045-8223
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
Other
Enumeration date
09/29/2022
Last updated
09/29/2022
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