Provider Demographics
NPI:1184059651
Name:LAIRD, DANA GARLAND (NP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:GARLAND
Last Name:LAIRD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:KUSHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 743294
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3294
Mailing Address - Country:US
Mailing Address - Phone:864-603-6300
Mailing Address - Fax:864-603-6160
Practice Address - Street 1:104 INNOVATION DR STE 2000
Practice Address - Street 2:BON SECOURS HEMATOLOGY & ONCOLOGY
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5253
Practice Address - Country:US
Practice Address - Phone:864-603-6300
Practice Address - Fax:864-603-6160
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2581Medicaid