Healthcare Provider Details

I. General information

NPI: 1407096191
Provider Name (Legal Business Name): STEPHEN GREENWOOD HEALTH TECH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 RIVERS AVE
NORTH CHARLESTON SC
29405-7747
US

IV. Provider business mailing address

3600 RIVERS AVE
NORTH CHARLESTON SC
29405-7747
US

V. Phone/Fax

Practice location:
  • Phone: 843-743-7868
  • Fax: 843-743-7521
Mailing address:
  • Phone: 843-743-7868
  • Fax: 843-743-7521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: