Provider Demographics
NPI:1891106472
Name:DICKEY, TONYA TAWANDA
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:TAWANDA
Last Name:DICKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E SMITH ST
Mailing Address - Street 2:
Mailing Address - City:TIMMONSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29161-1817
Mailing Address - Country:US
Mailing Address - Phone:843-346-3344
Mailing Address - Fax:843-346-3377
Practice Address - Street 1:105 E SMITH ST
Practice Address - Street 2:
Practice Address - City:TIMMONSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29161
Practice Address - Country:US
Practice Address - Phone:843-346-3344
Practice Address - Fax:843-346-3377
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)