Healthcare Provider Details

I. General information

NPI: 1174614531
Provider Name (Legal Business Name): DEPT OF VETERANS AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 AUGUSTA RD
GREENVILLE SC
29605-1302
US

IV. Provider business mailing address

3510 AUGUSTA RD
GREENVILLE SC
29605-1302
US

V. Phone/Fax

Practice location:
  • Phone: 864-299-1600
  • Fax: 864-422-2604
Mailing address:
  • Phone: 864-299-1600
  • Fax: 864-422-2604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number4776
License Number StateVT

VIII. Authorized Official

Name: DR. MOHAMMAD AIYUB KHAN
Title or Position: STAFF PHYSICIAN
Credential: MD
Phone: 864-299-1600