Organization
SOUTHLAKE OBGYN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACI GARNETT (OFFICE MANAGER)
(803) 359-3236
Entity
Organization
Contact information
Practice address
811 SOUTH LAKE DRIVE, LEXINGTON, SC 29072
(803) 359-3236
(803) 520-7584
Mailing address
811 SOUTH LAKE DRIVE, LEXINGTON, SC 29072
(803) 359-3236
(803) 520-7584
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3626
—
SC
Enumeration date
04/06/2006
Last updated
08/07/2012
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