Healthcare Provider Details

I. General information

NPI: 1760475057
Provider Name (Legal Business Name): WANDA J STARLING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 S BLACKSTOCK RD
LANDRUM SC
29356-9136
US

IV. Provider business mailing address

1014 S BLACKSTOCK RD
LANDRUM SC
29356-9136
US

V. Phone/Fax

Practice location:
  • Phone: 864-457-2033
  • Fax: 864-848-8551
Mailing address:
  • Phone: 864-457-2033
  • Fax: 864-848-8551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14152
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: