Provider Demographics
NPI:1003176678
Name:NEAL, DIANNA LYN (MD)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:LYN
Last Name:NEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6439 GARNERS FERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1639
Mailing Address - Country:US
Mailing Address - Phone:803-776-4000
Mailing Address - Fax:
Practice Address - Street 1:7182 WOODROW ST STE 200
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2958
Practice Address - Country:US
Practice Address - Phone:803-749-1111
Practice Address - Fax:803-749-0050
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEMD16519207Q00000X
GA45100207Q00000X
SC34763207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine