Healthcare Provider Details

I. General information

NPI: 1841742889
Provider Name (Legal Business Name): GREENVILLE MEDICAL ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 W BUTLER RD
GREENVILLE SC
29607-4833
US

IV. Provider business mailing address

545 W BUTLER RD
GREENVILLE SC
29607-4833
US

V. Phone/Fax

Practice location:
  • Phone: 864-299-1990
  • Fax: 864-299-9123
Mailing address:
  • Phone: 864-299-1990
  • Fax: 864-299-9123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20540
License Number StateSC

VIII. Authorized Official

Name: DR. NAVEEN REDDY BETHI
Title or Position: PRESIDENT
Credential: MD
Phone: 864-901-5876