Facts
- Status
- A
- Credential
- M.D.
- Type
- Individual
- Enumeration date
- 2014-06-09
- Last updated
- 2026-07-27
Specialties
Licenses
- License SC
- LL36978
- License SC
- 36978
Location
- Practice location
- 811 W MAIN ST STE 204
- City
- LEXINGTON SC
- Postal code
- 290722500
- Phone
- 803-359-8855
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.