Healthcare Provider Details

I. General information

NPI: 1033173778
Provider Name (Legal Business Name): PATRICK G LOLLIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 ARTHREX DR BLDG CENTRAL
PENDLETON SC
29670-9286
US

IV. Provider business mailing address

131 ROLLING CREEK TRL
WILLIAMSTON SC
29697-9140
US

V. Phone/Fax

Practice location:
  • Phone: 864-772-8550
  • Fax: 864-772-8551
Mailing address:
  • Phone: 864-884-1607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19121
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: