Healthcare Provider Details

I. General information

NPI: 1346744984
Provider Name (Legal Business Name): JOSHUA CALEB FARRIS MD/PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NA NA NA

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 INNOVATION DR
GREENVILLE SC
29607-5253
US

IV. Provider business mailing address

104 INNOVATION DR
GREENVILLE SC
29607-5253
US

V. Phone/Fax

Practice location:
  • Phone: 864-603-6200
  • Fax:
Mailing address:
  • Phone: 864-603-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number89879
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: