1780087130 NPI number — MRS. MORGAN HOLT PATERSON LPTA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780087130 NPI number — MRS. MORGAN HOLT PATERSON LPTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATERSON
Provider First Name:
MORGAN
Provider Middle Name:
HOLT
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLT
Provider Other First Name:
MORGAN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPTA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780087130
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2060 NORTHBROOK BLVD.
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
NORTH CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
834-797-5167
Provider Business Mailing Address Fax Number:
843-797-5723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2060 NORTHBROOK BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
N CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29406-9811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
834-797-5167
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2014

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: 225200000X , with the licence number:  3175 , 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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