1174962591 NPI number — FENEISHA ISALYN FRANKLIN MD

Table of content: FENEISHA ISALYN FRANKLIN MD (NPI 1174962591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174962591 NPI number — FENEISHA ISALYN FRANKLIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRANKLIN
Provider First Name:
FENEISHA
Provider Middle Name:
ISALYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FERVIL
Provider Other First Name:
FENEISHA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174962591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6069
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29171-6069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-796-7270
Provider Business Mailing Address Fax Number:
803-796-0106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 THOMPSON ST
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-796-7270
Provider Business Practice Location Address Fax Number:
803-796-0106
Provider Enumeration Date:
06/19/2013

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: 207QG0300X , with the licence number:  35910 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: LL35910 , 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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