Healthcare Provider Details

I. General information

NPI: 1598795965
Provider Name (Legal Business Name): LAURIE STRANGE CFO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320-C TWO NOTCH RD.
COLUMBIA SC
29223
US

IV. Provider business mailing address

9320-C TWO NOTCH RD.
COLUMBIA SC
29223
US

V. Phone/Fax

Practice location:
  • Phone: 803-462-1140
  • Fax: 803-462-1141
Mailing address:
  • Phone: 803-462-1140
  • Fax: 803-462-1141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number02720
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: