Provider Demographics
NPI:1083270912
Name:RAY, PRIMA DOROTHY (PA-C)
Entity Type:Individual
Prefix:
First Name:PRIMA
Middle Name:DOROTHY
Last Name:RAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 BARTON CREEK CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8027
Mailing Address - Country:US
Mailing Address - Phone:803-256-2286
Mailing Address - Fax:803-419-8430
Practice Address - Street 1:109 BARTON CREEK CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8027
Practice Address - Country:US
Practice Address - Phone:803-256-2286
Practice Address - Fax:803-419-8430
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL3224363A00000X
363AS0400X
SC3224363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3224OtherPA LICENSE