Individual
MIA LASSITER MEDLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
838 W MEETING ST, MEDICAL ARTS 5 SUITE H, LANCASTER, SC 29720
(803) 286-7633
Mailing address
838 W MEETING ST, MEDICAL ARTS 5 SUITE H, LANCASTER, SC 29720-6233
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2619
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2885PA
—
SC
Enumeration date
10/11/2016
Last updated
11/23/2021
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