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General NPI Number Information
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NPI Number | 1336934827
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Entity Type | Organization
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Legal Business Name | WEST GVLSC WELLNESS LLC
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 201 N MAIN ST FL 2
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City | GREENVILLE
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State | SC
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Zip | 29601-2197
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Country | US
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Telephone | 864-884-6859
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Fax |
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Provider Business Mailing Address
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Address Line | 14 MEADOW RESERVE PL
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-3692
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Country | US
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Telephone | 520-256-0317
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DARREN WEST
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Credential | MD
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Telephone | 520-256-0317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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