Healthcare Provider Details

I. General information

NPI: 1134819220
Provider Name (Legal Business Name): EMILY POLATTY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 MARSHALL RD
GREENWOOD SC
29646-3606
US

IV. Provider business mailing address

835 MAY RD
SALUDA SC
29138-8439
US

V. Phone/Fax

Practice location:
  • Phone: 864-941-5691
  • Fax:
Mailing address:
  • Phone: 864-377-5229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number226300
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: