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General NPI Number Information
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NPI Number | 1568875458
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Entity Type | Individual
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Provider Name | KATHRYN MILLS HOLLINS LIZARRIBAR MD
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Gender | Female
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Dates
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Enumeration Date | 06/09/2014
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 3600 FOREST DR STE 300
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City | COLUMBIA
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State | SC
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Zip | 29204-4057
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Country | US
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Telephone | 803-749-5101
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Fax |
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Provider Business Mailing Address
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Address Line | 220 FAISON DR
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City | COLUMBIA
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State | SC
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Zip | 29203-3210
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Country | US
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Telephone | 803-935-7140
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 37095
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License Number State | SC
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