Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 24421 | SC |
N | 208000000X | Pediatrician | 35088807 | OH |
Y | 2080P0203X | Pediatric Critical Care Doctor | 24421 | SC |
NPI | 1073684593 |
---|---|
Provider Name | Elizabeth Hayes Mack |
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 | 13/11/2006 |
Last Update Date | 12/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
244211 | (05) | SC |