Active NPI
Clarence Joseph Dollison Jr., MD
- Pediatrics Physician
- Columbia, SC
National Provider Identifier
1184654345
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 08009
- Practice address
- 2712 Middleburg Dr
Suite 101
Columbia, SC 29204-2415 - Phone
- (803) 254-4257
- Fax
- (803) 252-7334
- NPI assigned
- Jul 4, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 08009 | SC | Primary |
Addresses
Primary practice location
2712 Middleburg Dr
Suite 101
Columbia, SC 29204-2415
Mailing address
2712 Middleburg Dr
Suite 101
Columbia, SC 29204-2415
Phone (803) 254-4257
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 080094 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08009 | SC | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405468800000",
"number": "1184654345",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2712 MIDDLEBURG DR",
"address_2": "SUITE 101",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292042415",
"telephone_number": "803-254-4257",
"fax_number": "803-252-7334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2712 MIDDLEBURG DR",
"address_2": "SUITE 101",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292042415",
"telephone_number": "803-254-4257",
"fax_number": "803-252-7334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOLLISON",
"first_name": "CLARENCE",
"middle_name": "JOSEPH",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-04",
"last_updated": "2014-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "SC",
"license": "08009",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "080094",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.