Basic Information
| Provider Information | |||||||||
| NPI: | 1003176678 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEAL | ||||||||
| FirstName: | DIANNA | ||||||||
| MiddleName: | LYN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6439 GARNERS FERRY ROAD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292091639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037764000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7182 WOODROW ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | IRMO | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290632958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037491111 | ||||||||
| FaxNumber: | 8037490050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2012 | ||||||||
| LastUpdateDate: | 06/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD16519 | ME | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 45100 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 34763 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.