Healthcare Provider Details

I. General information

NPI: 1073468625
Provider Name (Legal Business Name): BRYAN LITTIG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PATEWOOD DR STE B400
GREENVILLE SC
29615-6306
US

IV. Provider business mailing address

200 PATEWOOD DR STE B400
GREENVILLE SC
29615-6306
US

V. Phone/Fax

Practice location:
  • Phone: 864-454-4368
  • Fax: 864-241-9232
Mailing address:
  • Phone: 864-454-4368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number31586
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: