Provider Demographics
NPI:1306995782
Name:LOCKHART, JOANN CONYERS
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:CONYERS
Last Name:LOCKHART
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 1:500 ACADEMY STREET
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556
Mailing Address - Country:US
Mailing Address - Phone:843-355-5533
Mailing Address - Fax:843-355-6297
Practice Address - Street 1:500 ACADEMY STREET
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556
Practice Address - Country:US
Practice Address - Phone:843-355-5533
Practice Address - Fax:843-355-6297
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCKIKI0392Medicaid