Provider Demographics
NPI:1992296172
Name:WANDA J STARLING MD LLC
Entity type:Organization
Organization Name:WANDA J STARLING MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:JENNINGS
Authorized Official - Last Name:STARLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-457-2033
Mailing Address - Street 1:1014 S BLACKSTOCK ROAD
Mailing Address - Street 2:
Mailing Address - City:LANDRUM
Mailing Address - State:SC
Mailing Address - Zip Code:29356-9136
Mailing Address - Country:US
Mailing Address - Phone:864-457-2033
Mailing Address - Fax:864-457-5504
Practice Address - Street 1:1014 S BLACKSTOCK ROAD
Practice Address - Street 2:
Practice Address - City:LANDRUM
Practice Address - State:SC
Practice Address - Zip Code:29356-9136
Practice Address - Country:US
Practice Address - Phone:864-457-2033
Practice Address - Fax:864-457-5504
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WANDA J STARLING MD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty