1073619847 NPI number — DEBORAH DAUGHTRY LEVERETTE MD MPH

Table of content: DEBORAH DAUGHTRY LEVERETTE MD MPH (NPI 1073619847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073619847 NPI number — DEBORAH DAUGHTRY LEVERETTE MD MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVERETTE
Provider First Name:
DEBORAH
Provider Middle Name:
DAUGHTRY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAUGHTRY
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
DELIGHT
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1073619847
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1530 RICHLAND ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29201-2611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-252-4042
Provider Business Mailing Address Fax Number:
803-252-7440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1530 RICHLAND ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29201-2611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-252-4042
Provider Business Practice Location Address Fax Number:
803-252-7440
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  8599 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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