Provider Demographics
NPI:1194089789
Name:HARLESTON, ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HARLESTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 PINNACLE PKWY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8390
Mailing Address - Country:US
Mailing Address - Phone:803-424-5161
Mailing Address - Fax:803-424-5795
Practice Address - Street 1:40 PINNACLE PKWY
Practice Address - Street 2:SUITE 212
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-8390
Practice Address - Country:US
Practice Address - Phone:803-424-5161
Practice Address - Fax:803-424-5795
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL34758207Q00000X
SCMD34758207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine