Healthcare Provider Details

I. General information

NPI: 1215043856
Provider Name (Legal Business Name): LEIGH M SPICER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 ISLAND PARK DR STE. 200
DANIEL ISLAND SC
29492-8112
US

IV. Provider business mailing address

201 SIGMA DR STE 100
SUMMERVILLE SC
29486-7715
US

V. Phone/Fax

Practice location:
  • Phone: 843-856-6402
  • Fax: 843-216-5068
Mailing address:
  • Phone: 843-856-6402
  • Fax: 843-216-5068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26739
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: