Individual
DR. KEITH WOODWARD LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
615 WESLEY DRIVE, SUITE 300, CHARLESTON, SC 29407
(843) 266-4400
(843) 577-0455
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(888) 472-0043
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15543
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110105130
RR MEDICARE
SC
01
—
110232037
RR MEDICARE
SC
05
—
155432
—
SC
01
—
P00754364
RAILROAD MC ID-RSFPN
SC
Enumeration date
05/03/2006
Last updated
04/23/2025
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