Provider Demographics
NPI:1336107879
Name:FUQUA, LINDA L (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:L
Last Name:FUQUA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 KATIE CT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-4068
Mailing Address - Country:US
Mailing Address - Phone:864-943-4279
Mailing Address - Fax:864-223-2642
Practice Address - Street 1:102 KATIE CT
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4068
Practice Address - Country:US
Practice Address - Phone:864-943-4279
Practice Address - Fax:864-223-2642
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21319208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG36974Medicaid
SCG36974Medicaid