Healthcare Provider Details

I. General information

NPI: 1255891107
Provider Name (Legal Business Name): ALYSSA DAVIES ALTHOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 PARK CREEK DR
GREENVILLE SC
29605-4270
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 864-522-2700
  • Fax: 864-522-2705
Mailing address:
  • Phone: 864-695-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number94266
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: