Healthcare Provider Details

I. General information

NPI: 1679509178
Provider Name (Legal Business Name): MICHAEL S MATHERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 BEAR DR
GREENVILLE SC
29605-4458
US

IV. Provider business mailing address

13 COUNTRY CLUB DR
GREENVILLE SC
29605-1114
US

V. Phone/Fax

Practice location:
  • Phone: 864-295-2131
  • Fax: 864-605-8556
Mailing address:
  • Phone: 864-232-6233
  • Fax: 864-605-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number8776
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: