Healthcare Provider Details

I. General information

NPI: 1851361463
Provider Name (Legal Business Name): GREENVILLE RADIOLOGY P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 W FARIS RD
GREENVILLE SC
29605-4444
US

IV. Provider business mailing address

1210 W FARIS RD
GREENVILLE SC
29605-4444
US

V. Phone/Fax

Practice location:
  • Phone: 864-295-4410
  • Fax: 864-269-1386
Mailing address:
  • Phone: 864-295-4410
  • Fax: 864-269-1386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES DAVID WILLIAMS
Title or Position: PRESIDENT
Credential: M D
Phone: 864-295-4410