Provider Demographics
NPI:1972869774
Name:DEBNAM, LILLIANNE MARIE LEWIS (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:LILLIANNE
Middle Name:MARIE LEWIS
Last Name:DEBNAM
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:LILLIANNE
Other - Middle Name:MARIE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:57 JESSAMINE AVE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-5837
Mailing Address - Country:US
Mailing Address - Phone:843-546-8686
Mailing Address - Fax:843-546-1353
Practice Address - Street 1:57 JESSAMINE AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-5837
Practice Address - Country:US
Practice Address - Phone:843-546-8686
Practice Address - Fax:843-546-1353
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC86761208000000X
390200000X
GA074570208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program