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Organization
LIBERTY DOCTORS LLC
Active
Organization
LIBERTY DOCTORS LLC
Active
Other names
Mackey Family Practice, Mobile Medical Consultants
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISSA C LARA (CHIEF EXECUTIVE OFFICER)
(843) 412-1590
Entity
Organization
Contact information
Practice address
8761 DORCHESTER RD STE 230, CHARLESTON, SC 29420-7322
(843) 471-2273
(843) 377-8180
Mailing address
8761 DORCHESTER RD STE 230, CHARLESTON, SC 29420-7322
(843) 412-1590
(843) 225-3549
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
SC
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
30704
SC
208000000X
Pediatrics Physician
—
SC
364SF0001X
Family Health Clinical Nurse Specialist
1804
SC
364SF0001X
Family Health Clinical Nurse Specialist
3438
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G50785
—
SC
05
—
GP6738
—
SC
01
—
SC6924A634
MEDICARE PTAN
SC
Enumeration date
10/27/2011
Last updated
06/02/2026
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