Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 4596 | SC |
NPI | 1033346713 |
---|---|
Provider Name | Lucia Pinckney Covington |
First Address | Murrells Inlet, SC 29576 |
Second Address | Murrells Inlet, SC 29576 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2009 |
Last Update Date | 29/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ZX4596 | (05) | SC |