1033346713 NPI number — LUCIA PINCKNEY COVINGTON DMD

Table of content: LUCIA PINCKNEY COVINGTON DMD (NPI 1033346713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033346713 NPI number — LUCIA PINCKNEY COVINGTON DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COVINGTON
Provider First Name:
LUCIA
Provider Middle Name:
PINCKNEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAWLINSON
Provider Other First Name:
LUCIA
Provider Other Middle Name:
PINCKNEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033346713
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
637 BELLAMY AVE
Provider Second Line Business Mailing Address:
UNIT B
Provider Business Mailing Address City Name:
MURRELLS INLET
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-947-0017
Provider Business Mailing Address Fax Number:
843-947-0668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
637 BELLAMY AVE
Provider Second Line Business Practice Location Address:
UNIT B
Provider Business Practice Location Address City Name:
MURRELLS INLET
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-947-0017
Provider Business Practice Location Address Fax Number:
843-947-0668
Provider Enumeration Date:
06/19/2009

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: 1223S0112X , with the licence number:  4596 , 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)

  • Identifier: ZX4596 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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