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NPI Code Detail

MEDICARE: MS. LAUREEN JUDY NOLL MD

MEDICARE: MS. LAUREEN JUDY NOLL MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0804XChild & Adolescent Psychiatry PhysicianMD17696SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1E0501OTHERNCMEDCOST ID #
2274073OTHERNCUNITED BEHAVIORAL HEALTH
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
42015854OTHERNCCIGNA ID #
51388NOTHERNCBCBS OF NC ID#

General Provider Information

NPI Number : 1144271867
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LAUREEN JUDY NOLL MD
Provider Business Mailing Address
First Line : 20 POWDERHORN RD
Second Line :
City : SIMPSONVILLE
State : SC
Zip : 29681-3399
Country : US
Telephone Number : 864-963-3421
Fax Number :
Provider Business Practice Location Address
First Line : 20 POWDERHORN RD
Second Line :
City : SIMPSONVILLE
State : SC
Zip : 29681-3399
Country : US
Telephone Number : 864-963-3421
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2006
Last Update Date : 02/09/2017

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