Healthcare Provider Details

I. General information

NPI: 1720189079
Provider Name (Legal Business Name): RICHARD GREADY FESSLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 AUGUSTA RD
GREENVILLE SC
29605-1302
US

IV. Provider business mailing address

12 W RED FOX TRL
GREENVILLE SC
29615-3751
US

V. Phone/Fax

Practice location:
  • Phone: 864-299-1600
  • Fax:
Mailing address:
  • Phone: 864-288-3144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number9322
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: