Healthcare Provider Details

I. General information

NPI: 1104865575
Provider Name (Legal Business Name): NOMITA JOSHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 E BUTLER ROAD BUILDING C-1
MAULDIN SC
29662-2172
US

IV. Provider business mailing address

401 GUESS ST SUITE 100
GREENVILLE SC
29605-4155
US

V. Phone/Fax

Practice location:
  • Phone: 864-284-0211
  • Fax: 864-284-0266
Mailing address:
  • Phone: 864-233-2744
  • Fax: 864-233-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number17799
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: