Provider Demographics
NPI:1679661912
Name:WILLCOX, LORRAINE PUSSER (MD)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:PUSSER
Last Name:WILLCOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:JUNE
Other - Middle Name:LORRAINE
Other - Last Name:WILLCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10925
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37939-0925
Mailing Address - Country:US
Mailing Address - Phone:865-766-8800
Mailing Address - Fax:865-450-9374
Practice Address - Street 1:805 PAMPLICO HWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6019
Practice Address - Country:US
Practice Address - Phone:843-664-3301
Practice Address - Fax:843-664-3723
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25452207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC254520Medicaid
SC254520Medicaid