Provider Demographics
NPI:1629583612
Name:EZ&A LLC
Entity Type:Organization
Organization Name:EZ&A LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MA
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-441-2915
Mailing Address - Street 1:4683 CABOL RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:SC
Mailing Address - Zip Code:29742-6785
Mailing Address - Country:US
Mailing Address - Phone:864-441-2915
Mailing Address - Fax:
Practice Address - Street 1:4683 CABOL RD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:SC
Practice Address - Zip Code:29742-6785
Practice Address - Country:US
Practice Address - Phone:864-441-2915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0463562182083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty