Healthcare Provider Details

I. General information

NPI: 1740025584
Provider Name (Legal Business Name): STEPHANIE MCLEOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 ELECTRIC DR
SUMTER SC
29153
US

IV. Provider business mailing address

775 ELECTRIC DRIVE
SUMTER SC
29153
US

V. Phone/Fax

Practice location:
  • Phone: 803-905-5100
  • Fax: 803-905-5170
Mailing address:
  • Phone: 803-905-5100
  • Fax: 803-905-5170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: