Basic Information
| Provider Information | |||||||||
| NPI: | 1003885526 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POLKEY | ||||||||
| FirstName: | FAITH | ||||||||
| MiddleName: | LAWRENCE | ||||||||
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| Credential: | M.D., M.P.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1320 RIBAUT RD | ||||||||
| Address2: | |||||||||
| City: | PORT ROYAL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299351118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8439860900 | ||||||||
| FaxNumber: | 8433221875 | ||||||||
| Practice Location | |||||||||
| Address1: | 1320 RIBAUT RD | ||||||||
| Address2: | |||||||||
| City: | PORT ROYAL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299351118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8439860900 | ||||||||
| FaxNumber: | 8433221875 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 03/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 23511 | SC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.