Healthcare Provider Details

I. General information

NPI: 1538781471
Provider Name (Legal Business Name): LEE FORE MOYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E CAMDEN AVE
HARTSVILLE SC
29550-5726
US

IV. Provider business mailing address

130 E CAMDEN AVE
HARTSVILLE SC
29550-5726
US

V. Phone/Fax

Practice location:
  • Phone: 843-332-7303
  • Fax:
Mailing address:
  • Phone: 843-332-7303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number46123
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: