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General NPI Number Information
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NPI Number | 1205500204
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Entity Type | Individual
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Provider Name | ALECIA B FRIERSON
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Gender | Female
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Dates
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Enumeration Date | 08/03/2021
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | 400 MOORE ST
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City | LAKE CITY
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State | SC
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Zip | 29560-3314
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Country | US
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Telephone | 843-699-9127
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Fax | 843-699-9136
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Provider Business Mailing Address
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Address Line | 627 GREEN HAVEN AVE
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City | LAKE CITY
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State | SC
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Zip | 29560-4237
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Country | US
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Telephone | 843-229-7419
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | IHPC-1526
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License Number State | SC
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