Healthcare Provider Details

I. General information

NPI: 1265850283
Provider Name (Legal Business Name): LAURENS COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 HUMAN SERVICES RD
CLINTON SC
29325-7546
US

IV. Provider business mailing address

93 HUMAN SERVICES RD
CLINTON SC
29325-7546
US

V. Phone/Fax

Practice location:
  • Phone: 864-833-0000
  • Fax:
Mailing address:
  • Phone: 864-833-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberLPN.21894 P
License Number StateSC

VIII. Authorized Official

Name: ANGELA DIANNE JETER
Title or Position: CLINICAL NURSE
Credential: LPN
Phone: 864-833-0000