Individual
MR. JONATHAN DANIEL DIVEGLIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6439 GARNERS FERRY RD, COLUMBIA, SC 29209-1638
(803) 776-4000
(803) 695-6877
Mailing address
238 HIGH POINTE DR, BLYTHEWOOD, SC 29016-7608
(603) 312-5181
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
532208
SC
Other
Enumeration date
12/13/2024
Last updated
12/13/2024
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