Provider Demographics
NPI:1952874877
Name:MCDONALD, SABRINA
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 FOLK ST
Mailing Address - Street 2:
Mailing Address - City:POMARIA
Mailing Address - State:SC
Mailing Address - Zip Code:29126-8918
Mailing Address - Country:US
Mailing Address - Phone:803-537-2863
Mailing Address - Fax:
Practice Address - Street 1:320 FOLK ST
Practice Address - Street 2:
Practice Address - City:POMARIA
Practice Address - State:SC
Practice Address - Zip Code:29126-8918
Practice Address - Country:US
Practice Address - Phone:803-537-2863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC004057175347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle