Provider Demographics
NPI:1457412009
Name:EMERSON, MARY ALLYSON (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ALLYSON
Last Name:EMERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ALLYSON
Other - Last Name:WHERREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7950
Mailing Address - Fax:843-292-9352
Practice Address - Street 1:800 E CHEVES ST
Practice Address - Street 2:SUITE 240
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2650
Practice Address - Country:US
Practice Address - Phone:843-777-7950
Practice Address - Fax:843-292-9352
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC261932Medicaid