=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699136705
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEIGH ABIGAIL GARRISON COLEMAN DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2016
-----------------------------------------------------
Last Update Date | 11/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3710 HIGHWAY 72 221 E
-----------------------------------------------------
City | GREENWOOD
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29649-9615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-407-4455
-----------------------------------------------------
Fax | 864-407-4454
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 429 LONGVIEW TER
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29605-1023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-940-3288
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 9024
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------