Provider Demographics
NPI:1750403713
Name:WADDELL, LISA F (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:F
Last Name:WADDELL
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 PEBBLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-3112
Mailing Address - Country:US
Mailing Address - Phone:803-699-8126
Mailing Address - Fax:
Practice Address - Street 1:1751 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2606
Practice Address - Country:US
Practice Address - Phone:803-898-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC169932083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine