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General NPI Number Information
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NPI Number | 1639127616
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Entity Type | Individual
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Provider Name | LAWTON HARIS SALLEY MD
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Gender | Male
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 970 HOLLY ST
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City | ORANGEBURG
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State | SC
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Zip | 29115-4930
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Country | US
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Telephone | 803-534-5929
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Fax | 803-535-0540
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Provider Business Mailing Address
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Address Line | 970 HOLLY ST
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City | ORANGEBURG
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State | SC
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Zip | 29115-4930
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Country | US
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Telephone | 803-534-5929
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Fax | 803-535-0540
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4585
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License Number State | SC
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