Healthcare Provider Details

I. General information

NPI: 1760461404
Provider Name (Legal Business Name): SYNERGY PHYSICIAN GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 E BY PASS 123
SENECA SC
29678-0842
US

IV. Provider business mailing address

457 E BY PASS 123
SENECA SC
29678-0842
US

V. Phone/Fax

Practice location:
  • Phone: 864-886-9888
  • Fax: 864-886-9777
Mailing address:
  • Phone: 864-886-9888
  • Fax: 864-886-9777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: TAMMY CHAMBERS
Title or Position: ADMINISTRATOR
Credential:
Phone: 864-882-8850