Healthcare Provider Details

I. General information

NPI: 1679278329
Provider Name (Legal Business Name): CHASE RATHFOOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 PHYSICIANS DR
GREER SC
29650-2446
US

IV. Provider business mailing address

109 PHYSICIANS DR
GREER SC
29650-2446
US

V. Phone/Fax

Practice location:
  • Phone: 864-797-8856
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberLL90119
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: