Healthcare Provider Details

I. General information

NPI: 1538856331
Provider Name (Legal Business Name): ERIKA SUE LEECH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CREEL ST
CONWAY SC
29527-5018
US

IV. Provider business mailing address

300 SINGLETON RIDGE RD ATTN CREDENTIALING
CONWAY SC
29526
US

V. Phone/Fax

Practice location:
  • Phone: 843-248-4414
  • Fax: 843-248-3781
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number89766
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: