Healthcare Provider Details

I. General information

NPI: 1427496025
Provider Name (Legal Business Name): LILIKA WHITE LATSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LILIKA ANIQUE WHITE

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BRUSHY CREEK RD
EASLEY SC
29642-2200
US

IV. Provider business mailing address

700 BRUSHY CREEK RD
EASLEY SC
29642-2200
US

V. Phone/Fax

Practice location:
  • Phone: 864-306-9661
  • Fax:
Mailing address:
  • Phone: 864-306-9661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR0154
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number97681
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18811
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: