Healthcare Provider Details

I. General information

NPI: 1821100835
Provider Name (Legal Business Name): SUSAN HAMMOND GROSSLIGHT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/22/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 W MOULTRIE ST SUITE 200
WINNSBORO SC
29180-2411
US

IV. Provider business mailing address

PO BOX 1218
WINNSBORO SC
29180-5218
US

V. Phone/Fax

Practice location:
  • Phone: 803-635-6461
  • Fax: 803-635-4200
Mailing address:
  • Phone: 803-635-6461
  • Fax: 803-635-4200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License NumberR41098
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17725
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: