Healthcare Provider Details

I. General information

NPI: 1841808359
Provider Name (Legal Business Name): LORI HUNTER HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 AUGUSTA RD STE B
WEST COLUMBIA SC
29170-3319
US

IV. Provider business mailing address

318 CAROLA LN
LEXINGTON SC
29072-3941
US

V. Phone/Fax

Practice location:
  • Phone: 803-543-2782
  • Fax:
Mailing address:
  • Phone: 803-543-2782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number0674
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: