Provider Demographics
NPI:1467447631
Name:HARDING, LISA G (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:G
Last Name:HARDING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:GAY
Other - Last Name:BROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1648 GENTRY MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-8877
Mailing Address - Country:US
Mailing Address - Phone:864-855-1331
Mailing Address - Fax:864-855-1602
Practice Address - Street 1:1648 GENTRY MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-8877
Practice Address - Country:US
Practice Address - Phone:864-855-1331
Practice Address - Fax:864-855-1602
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27365207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC273652Medicaid
SC273652Medicaid
SCH53484Medicare UPIN
SCH534843158Medicare ID - Type UnspecifiedGROUP
SCH534843158Medicare PIN