Provider Demographics
NPI:1164651667
Name:DION, KELLY T (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:T
Last Name:DION
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 LANDMARK DR STE 202
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-4034
Mailing Address - Country:US
Mailing Address - Phone:803-708-9591
Mailing Address - Fax:803-708-9661
Practice Address - Street 1:3710 LANDMARK DR STE 202
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4034
Practice Address - Country:US
Practice Address - Phone:803-708-9591
Practice Address - Fax:803-708-9661
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC317952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC317954Medicaid