Healthcare Provider Details

I. General information

NPI: 1780969329
Provider Name (Legal Business Name): LAUREN MURPHY OTT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 DORANGE RD
BRANCHVILLE SC
29432-2241
US

IV. Provider business mailing address

1773 VILLAGE PARK DR
ORANGEBURG SC
29118-2475
US

V. Phone/Fax

Practice location:
  • Phone: 803-395-3650
  • Fax: 803-274-8817
Mailing address:
  • Phone: 803-535-3600
  • Fax: 803-534-6300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: