MEDICARE: ELIZABETH HARLESTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	LL34758	SC
2	207Q00000X	Family Medicine Physician	MD34758	SC

General Provider Information

NPI Number	:	1194089789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH HARLESTON M.D.

Provider Business Mailing Address
First Line	:	40 PINNACLE PKWY
Second Line	:	SUITE 212
City	:	ELGIN
State	:	SC
Zip	:	29045-8390
Country	:	US
Telephone Number	:	803-424-5161
Fax Number	:	803-424-5795

Provider Business Practice Location Address
First Line	:	40 PINNACLE PKWY
Second Line	:	SUITE 212
City	:	ELGIN
State	:	SC
Zip	:	29045-8390
Country	:	US
Telephone Number	:	803-424-5161
Fax Number	:	803-424-5795

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2012
Last Update Date	:	04/08/2016

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