Provider Demographics
NPI:1407873086
Name:CONYERS, ELIZABETH HARRISON (PAC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:HARRISON
Last Name:CONYERS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:C
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:116 ILEX LN
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-8227
Mailing Address - Country:US
Mailing Address - Phone:903-245-5353
Mailing Address - Fax:
Practice Address - Street 1:111 MIRACLE DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6351
Practice Address - Country:US
Practice Address - Phone:803-641-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002475363A00000X
KYPA1654363A00000X
SC3964363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK020390OtherMEDICARE
IAP01352419OtherRR MEDICARE
IAIB2621053Medicare PIN