Healthcare Provider Details

I. General information

NPI: 1295715159
Provider Name (Legal Business Name): RONALD G ESLICK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 LINER DR
GREENWOOD SC
29646-2311
US

IV. Provider business mailing address

PO BOX 819
GREENWOOD SC
29648-0819
US

V. Phone/Fax

Practice location:
  • Phone: 864-227-3636
  • Fax: 864-227-6116
Mailing address:
  • Phone: 864-227-8242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR42506
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: