Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 34763 | SC |
N | 207Q00000X | Family Doctor | 45100 | GA |
N | 207Q00000X | Family Doctor | MD16519 | ME |
NPI | 1003176678 |
---|---|
Provider Name | Dianna Lyn Neal |
First Address | Columbia, SC 29209-1639 |
Second Address | Irmo, SC 29063-2958 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2012 |
Last Update Date | 02/06/2021 |