Provider Demographics
NPI:1417037078
Name:ALLISON, LEE LOVETT (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:LOVETT
Last Name:ALLISON
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 1:1200 TWO ISLAND CT
Mailing Address - Street 2:SUITE E
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7418
Mailing Address - Country:US
Mailing Address - Phone:843-849-1300
Mailing Address - Fax:843-849-1310
Practice Address - Street 1:1200 TWO ISLAND CT
Practice Address - Street 2:SUITE E
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7418
Practice Address - Country:US
Practice Address - Phone:843-849-1300
Practice Address - Fax:843-849-1310
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC288646Medicaid
SCAA41559314Medicare PIN