Healthcare Provider Details

I. General information

NPI: 1336347319
Provider Name (Legal Business Name): GREENWOOD CENTER FOR GYNECOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 A EDGEFIELD ST
GREENWOOD SC
29646-3205
US

IV. Provider business mailing address

1029 A EDGEFIELD ST
GREENWOOD SC
29646-3205
US

V. Phone/Fax

Practice location:
  • Phone: 864-388-2122
  • Fax: 864-388-7948
Mailing address:
  • Phone: 864-388-2122
  • Fax: 864-388-7948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number18669
License Number StateSC

VIII. Authorized Official

Name: PAULA B. HINTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 864-388-2122