Provider Demographics
NPI:1881648319
Name:ALFORD, SIENA SHIELDS (DO)
Entity Type:Individual
Prefix:DR
First Name:SIENA
Middle Name:SHIELDS
Last Name:ALFORD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-3633
Mailing Address - Country:US
Mailing Address - Phone:843-488-4300
Mailing Address - Fax:843-488-4301
Practice Address - Street 1:1210 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-3633
Practice Address - Country:US
Practice Address - Phone:843-488-4300
Practice Address - Fax:843-488-4301
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL0665Medicaid
SC42D0940858OtherCLIA LABRATORY NUMBER
SCTL0665Medicaid
SCE325848035Medicare ID - Type UnspecifiedMEDICARE NUMBER