Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A115704 | CA |
N | 208600000X | Surgeon | A115704 | CA |
Y | 2086S0102X | Surgical Critical Care | 36036 | SC |
N | 2086S0102X | Surgical Critical Care | A115704 | CA |
N | 2086S0127X | Trauma Surgeon | A115704 | CA |
NPI | 1457573313 |
---|---|
Provider Name | Dr. Alicia Renee Privette |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-8908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 09/07/2013 |