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General NPI Number Information
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NPI Number | 1710849369
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Entity Type | Organization
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Legal Business Name | GREEN SPOT MEDISPA LLC
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 910 S CASHUA DR UNIT B
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City | FLORENCE
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State | SC
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Zip | 29501-6313
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Country | US
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Telephone | 843-905-7674
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Fax |
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Provider Business Mailing Address
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Address Line | 910 S CASHUA DR UNIT B
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City | FLORENCE
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State | SC
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Zip | 29501-6313
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Country | US
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Telephone | 843-905-7674
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DAISHA JERRICE GREEN
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Credential | FNP
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Telephone | 843-260-0529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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