Healthcare Provider Details

I. General information

NPI: 1972417749
Provider Name (Legal Business Name): NICHOLAS GREYDON RAUCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FLEETWOOD DR
EASLEY SC
29640-2022
US

IV. Provider business mailing address

200 FLEETWOOD DR
EASLEY SC
29640-2022
US

V. Phone/Fax

Practice location:
  • Phone: 864-442-7708
  • Fax:
Mailing address:
  • Phone: 864-442-7708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number279023
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: