Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 23511 | SC |
NPI | 1003885526 |
---|---|
Provider Name | Faith Lawrence Polkey |
First Address | Port Royal, SC 29935-1118 |
Second Address | Port Royal, SC 29935-1118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 10/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H46791 | (02) | SC |