Provider Demographics
NPI:1649280231
Name:HIGH, PATRICE L (DO)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:L
Last Name:HIGH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 S SEVENTH ST
Mailing Address - Street 2:
Mailing Address - City:MC BEE
Mailing Address - State:SC
Mailing Address - Zip Code:29101-7101
Mailing Address - Country:US
Mailing Address - Phone:843-335-8291
Mailing Address - Fax:843-335-8731
Practice Address - Street 1:40 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:LUGOFF
Practice Address - State:SC
Practice Address - Zip Code:29078-9406
Practice Address - Country:US
Practice Address - Phone:803-408-3262
Practice Address - Fax:803-408-8895
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC699207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC006996Medicaid
SCP00210646OtherMEDICARE RAILROAD
SCP00210646OtherMEDICARE RAILROAD