Provider Demographics
NPI:1376039461
Name:CARRAWAY, VIRGINIA NEELY TODD (DMD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:NEELY TODD
Last Name:CARRAWAY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:NEELY
Other - Last Name:TODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:105 SHERINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-2615
Mailing Address - Country:US
Mailing Address - Phone:864-421-5154
Mailing Address - Fax:
Practice Address - Street 1:105 SHERINGHAM DR
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-2615
Practice Address - Country:US
Practice Address - Phone:864-421-5154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC91541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice