Healthcare Provider Details

I. General information

NPI: 1740285899
Provider Name (Legal Business Name): LESLIE CAROL STANFIELD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 10/14/2026
Certification Date: 10/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 HARDEN ST STE B
COLUMBIA SC
29204-1800
US

IV. Provider business mailing address

PO BOX 19305
CHARLOTTE NC
28219-9305
US

V. Phone/Fax

Practice location:
  • Phone: 803-748-7002
  • Fax: 803-252-5259
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17954
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200401438
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: