Healthcare Provider Details

I. General information

NPI: 1891788907
Provider Name (Legal Business Name): DIGESTIVE DISEASE GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 LINER DR
GREENWOOD SC
29646-2311
US

IV. Provider business mailing address

103 LINER DR
GREENWOOD SC
29646-2311
US

V. Phone/Fax

Practice location:
  • Phone: 864-227-3636
  • Fax: 864-227-6116
Mailing address:
  • Phone: 864-227-3636
  • Fax: 864-227-6116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: APRIL CRISP
Title or Position: PRACTICE MANAGER
Credential:
Phone: 864-396-2221