=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518913896
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDRA R LOVE M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2006
-----------------------------------------------------
Last Update Date | 06/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 877 W FARIS RD SUITE D
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29605-4254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-455-9050
-----------------------------------------------------
Fax | 864-455-9017
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ONE INDEPENDENCE POINTE SUITE 212
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29615-4566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-797-6044
-----------------------------------------------------
Fax | 864-797-6198
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 16551
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------