Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | LL51326 | SC |
NPI | 1093235715 |
---|---|
Provider Name | Dr. Laura Mackenzie Harbin |
First Address | Charleston, SC 29403-6107 |
Second Address | Charleston, SC 29425-8900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2017 |
Last Update Date | 23/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
LL51326 | LIMITED LICENSE (01) | SC |