Healthcare Provider Details

I. General information

NPI: 1588084057
Provider Name (Legal Business Name): ELIZABETH MARIE MANNION M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GROVE RD FL 1
GREENVILLE SC
29605-4210
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-7899
  • Fax: 864-455-5474
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number52312
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: