Healthcare Provider Details

I. General information

NPI: 1083972772
Provider Name (Legal Business Name): GRACE DANIEL DUKES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 W FARIS RD
GREENVILLE SC
29605-4446
US

IV. Provider business mailing address

1190 W FARIS RD
GREENVILLE SC
29605-4446
US

V. Phone/Fax

Practice location:
  • Phone: 864-522-1880
  • Fax:
Mailing address:
  • Phone: 864-522-1880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number52578
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberIP1339
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: