Healthcare Provider Details

I. General information

NPI: 1609293125
Provider Name (Legal Business Name): LESLIE POSTON FLOYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 N ACLINE ST
LAKE CITY SC
29560-2107
US

IV. Provider business mailing address

6840 LANGSTON RD
TIMMONSVILLE SC
29161-8510
US

V. Phone/Fax

Practice location:
  • Phone: 843-394-8822
  • Fax:
Mailing address:
  • Phone: 843-661-5637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number96301
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: