Individual
DR. LAURICE DOMINICK INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMSC, PA-C
Contact information
Practice address
4994 MORRISON RD, RICHBURG, SC 29729-9072
(803) 789-6106
Mailing address
4994 MORRISON RD, RICHBURG, SC 29729-9072
(803) 789-6106
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3378
SC
Other
Enumeration date
11/25/2019
Last updated
12/28/2022
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