Provider Demographics
NPI:1073619847
Name:LEVERETTE, DEBORAH DAUGHTRY (MD MPH)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:DAUGHTRY
Last Name:LEVERETTE
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:DELIGHT
Other - Last Name:DAUGHTRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1530 RICHLAND ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2611
Mailing Address - Country:US
Mailing Address - Phone:803-252-4042
Mailing Address - Fax:803-252-7440
Practice Address - Street 1:1530 RICHLAND ST
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2611
Practice Address - Country:US
Practice Address - Phone:803-252-4042
Practice Address - Fax:803-252-7440
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC85992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry