Provider Demographics
NPI:1508026444
Name:LARSON, AMANDA TURBEVILLE (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:TURBEVILLE
Last Name:LARSON
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:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-399-9774
Mailing Address - Fax:843-399-8657
Practice Address - Street 1:3980 HIGHWAY 9 E
Practice Address - Street 2:SUITE 100-C
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-8163
Practice Address - Country:US
Practice Address - Phone:843-399-9774
Practice Address - Fax:843-399-8657
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35895208600000X, 207Q00000X
NC2016-00161208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery