Healthcare Provider Details

I. General information

NPI: 1588614366
Provider Name (Legal Business Name): HUMA S AFTAB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 ENTERPRISE DR
EASLEY SC
29642-8280
US

IV. Provider business mailing address

PO BOX 2583
GREENVILLE SC
29602-2583
US

V. Phone/Fax

Practice location:
  • Phone: 864-365-0290
  • Fax:
Mailing address:
  • Phone: 864-232-2734
  • Fax: 864-232-8126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25921
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: