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General NPI Number Information
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NPI Number | 1619394624
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Entity Type | Individual
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Provider Name | LILLIE JAMES
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Gender | Female
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Dates
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Enumeration Date | 03/27/2014
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Last Update Date | 03/27/2014
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Provider Practice Location Address
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Address Line | 1931 INDUSTRIAL PARK RD
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City | CONWAY
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State | SC
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Zip | 29526-5482
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Country | US
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Telephone | 843-915-5655
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Fax | 843-915-6477
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Provider Business Mailing Address
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Address Line | 1950 HERITAGE RD
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City | LORIS
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State | SC
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Zip | 29569-6734
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Country | US
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 77314
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 77314
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License Number State | SC
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