Healthcare Provider Details

I. General information

NPI: 1770531972
Provider Name (Legal Business Name): LLOYD E HEPBURN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 EAGLE LANDING BLVD
NORTH CHARLESTON SC
29406-4074
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-5747
  • Fax: 843-797-0857
Mailing address:
  • Phone: 843-789-1620
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18279
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: