Provider Demographics
NPI:1184615825
Name:CLARKSON, LOLA B (MD)
Entity type:Individual
Prefix:DR
First Name:LOLA
Middle Name:B
Last Name:CLARKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LOLA
Other - Middle Name:K
Other - Last Name:CLARKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:101 GREGOR MENDEL CIR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-2316
Mailing Address - Country:US
Mailing Address - Phone:864-941-8100
Mailing Address - Fax:864-941-8114
Practice Address - Street 1:1911 THURMOND MALL
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2375
Practice Address - Country:US
Practice Address - Phone:803-799-5390
Practice Address - Fax:803-799-5391
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13601207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC136016Medicaid
SCE83486Medicare UPIN
SCE834861614Medicare ID - Type Unspecified