Healthcare Provider Details

I. General information

NPI: 1982665121
Provider Name (Legal Business Name): RONALD TOLLISON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 S BUNCOMBE RD
GREER SC
29650-1207
US

IV. Provider business mailing address

800 PELHAM RD
GREENVILLE SC
29615-3300
US

V. Phone/Fax

Practice location:
  • Phone: 864-877-9883
  • Fax: 864-284-0844
Mailing address:
  • Phone: 864-234-5800
  • Fax: 864-284-0844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10296
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: