Provider Demographics
NPI:1376582858
Name:HUMPHREYS, TONYA M (PA)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:M
Last Name:HUMPHREYS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1818 HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2619
Mailing Address - Country:US
Mailing Address - Phone:803-758-2600
Mailing Address - Fax:803-726-3141
Practice Address - Street 1:459 N HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3924
Practice Address - Country:US
Practice Address - Phone:843-899-3872
Practice Address - Fax:843-899-3877
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-12-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC1072363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1069402OtherNCCPA
SC0391PAMedicaid
SCAA1344A634OtherMEDICARE PTAN