Provider Demographics
NPI:1346498185
Name:DYSON, ASHLEY ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ELIZABETH
Last Name:DYSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:ELIZABETH
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:148 RIVERVALLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:803-270-2676
Mailing Address - Fax:434-947-5971
Practice Address - Street 1:2117 GERVAIS STREET
Practice Address - Street 2:WAVERLY FAMILY PRACTICE
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204
Practice Address - Country:US
Practice Address - Phone:803-748-1181
Practice Address - Fax:803-748-1185
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0110002853363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1849390OtherFEDERAL DEA