MEDICARE: SYLVIA LEE CLARKSON 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	51950	SC

General Provider Information

NPI Number	:	1790166163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYLVIA LEE CLARKSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 602108
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-2108
Country	:	US
Telephone Number	:	843-876-8333
Fax Number	:	843-876-8330

Provider Business Practice Location Address
First Line	:	1440 BEN SAWYER BLVD STE 1109
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-5526
Country	:	US
Telephone Number	:	843-876-8333
Fax Number	:	843-876-8330

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

Provider Enumeration Date	:	06/11/2015
Last Update Date	:	10/08/2020

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