Healthcare Provider Details

I. General information

NPI: 1952252330
Provider Name (Legal Business Name): UPCOUNTRY PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1736 OLD YORK RD
YORK SC
29745-9458
US

IV. Provider business mailing address

6 BROAD ST
YORK SC
29745-1112
US

V. Phone/Fax

Practice location:
  • Phone: 864-685-7915
  • Fax:
Mailing address:
  • Phone: 803-981-4962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GRETCHEN COADY
Title or Position: CEO / PRESIDENT
Credential: MD
Phone: 803-981-4962