Healthcare Provider Details

I. General information

NPI: 1487649729
Provider Name (Legal Business Name): LILLIE EDWARDS BATES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W MAIN ST STE 204
LEXINGTON SC
29072-2507
US

IV. Provider business mailing address

PO BOX 6069
WEST COLUMBIA SC
29171-6069
US

V. Phone/Fax

Practice location:
  • Phone: 803-359-8855
  • Fax: 803-359-1257
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15599
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: