Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 81721 | SC |
N | 207QA0505X | Family Doctor - Adult Medicine | 51010119542 | MI |
NPI | 1033417522 |
---|---|
Provider Name | Lisa Centilli |
First Address | Georgetown, SC 29442-4203 |
Second Address | Murrells Inlet, SC 29576 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2011 |
Last Update Date | 16/03/2021 |