Provider Demographics
NPI:1568889079
Name:MCCRARY, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:MCCRARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 37
Mailing Address - Street 2:HAMPTON COUNTY HEALTH DEPARTMEN
Mailing Address - City:HAMPTON
Mailing Address - State:SC
Mailing Address - Zip Code:29924
Mailing Address - Country:US
Mailing Address - Phone:803-943-3878
Mailing Address - Fax:803-943-1067
Practice Address - Street 1:531 WEST CAROLINA AVE. WEST
Practice Address - Street 2:
Practice Address - City:VARNVILLE
Practice Address - State:SC
Practice Address - Zip Code:29944
Practice Address - Country:US
Practice Address - Phone:803-943-3878
Practice Address - Fax:803-943-1067
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28621163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health