Healthcare Provider Details

I. General information

NPI: 1801487525
Provider Name (Legal Business Name): ELIZABETH HULL DENNISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 THOMPSON ST, STE 100
LEXINGTON SC
29072
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: 803-359-8855
  • Fax: 803-359-1257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL86124
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number86124
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: