Provider Demographics
NPI:1336573179
Name:SPRADLEY OGLESBY, LAUREN ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELAINE
Last Name:SPRADLEY OGLESBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ELAINE
Other - Last Name:SPRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:955 RIBAUT RD
Mailing Address - Street 2:ATTN: BMAC CREDENTIALING
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5441
Mailing Address - Country:US
Mailing Address - Phone:843-522-7843
Mailing Address - Fax:843-522-5945
Practice Address - Street 1:1000 PINE ST W
Practice Address - Street 2:
Practice Address - City:VARNVILLE
Practice Address - State:SC
Practice Address - Zip Code:29944-4750
Practice Address - Country:US
Practice Address - Phone:803-943-5228
Practice Address - Fax:844-295-9899
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN61140207R00000X, 208000000X
SC86367207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics