Healthcare Provider Details

I. General information

NPI: 1750901534
Provider Name (Legal Business Name): CATHERINE EVE ENYART MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CATHERINE EVE TISDALE MD

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 REIDVILLE RD STE 102
SPARTANBURG SC
29301-3652
US

IV. Provider business mailing address

CB 7593
CHAPEL HILL NC
27599-0001
US

V. Phone/Fax

Practice location:
  • Phone: 864-272-0388
  • Fax: 336-832-3151
Mailing address:
  • Phone: 919-966-3172
  • Fax: 919-966-8419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number89596
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: