Healthcare Provider Details

I. General information

NPI: 1003404450
Provider Name (Legal Business Name): NORTH GREENVILLE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 N TIGERVILLE RD
TIGERVILLE SC
29688-9700
US

IV. Provider business mailing address

7801 N TIGERVILLE RD
TIGERVILLE SC
29688-9700
US

V. Phone/Fax

Practice location:
  • Phone: 864-867-4677
  • Fax:
Mailing address:
  • Phone: 864-867-4677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES ANDERSON
Title or Position: DIRECTOR OF SPORTS MEDICINE
Credential: ATC
Phone: 864-867-4677