Healthcare Provider Details

I. General information

NPI: 1356638613
Provider Name (Legal Business Name): CARA LASLEY D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E CHEVES ST
FLORENCE SC
29506-2617
US

IV. Provider business mailing address

PO BOX 746645
ATLANTA GA
30374-6645
US

V. Phone/Fax

Practice location:
  • Phone: 843-777-2000
  • Fax:
Mailing address:
  • Phone: 904-376-4083
  • Fax: 904-391-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT-2504
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code2080P1004X
TaxonomyPhysician Nutrition Specialist (Pediatrics)
License Number93899
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberOS19066
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberC2-0012727
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: