Provider Demographics
NPI:1467520213
Name:TURNER, LAURIE MILLER (PA)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:MILLER
Last Name:TURNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2109
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29503-2109
Mailing Address - Country:US
Mailing Address - Phone:843-661-0500
Mailing Address - Fax:843-661-7370
Practice Address - Street 1:214 W. PINE ST.
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4725
Practice Address - Country:US
Practice Address - Phone:843-661-0500
Practice Address - Fax:843-661-7370
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC981EM363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0514PAMedicaid
SC7153OtherMEDICARE GROUP NUMBER
SCGP4377OtherMEDICAID GROUP NUMBER
SCQ67031Medicare UPIN
SCAA12857153Medicare PIN