=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235192972
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY C SWEET PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2006
-----------------------------------------------------
Last Update Date | 06/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 DOCTORS DR
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29605-5622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-797-7150
-----------------------------------------------------
Fax | 864-797-7155
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 E MCBEE AVE FL 4
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29601-2842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-522-8614
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 1007
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------