Provider Demographics
NPI:1336761188
Name:COSTON, CARIANNA (DO)
Entity Type:Individual
Prefix:
First Name:CARIANNA
Middle Name:
Last Name:COSTON
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:PO BOX 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-512-5955
Mailing Address - Fax:864-512-5957
Practice Address - Street 1:3501 CLEMSON BLVD STE 1
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1328
Practice Address - Country:US
Practice Address - Phone:864-512-3452
Practice Address - Fax:684-512-3453
Is Sole Proprietor?:No
Enumeration Date:2020-05-15
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC83153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine