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General NPI Number Information
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NPI Number | 1720053309
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Entity Type | Organization
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Legal Business Name | SPARTANBURG PATHOLOGY CONSULTANTS PA
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Dates
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Enumeration Date | 02/17/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 106 VENTURE BLVD
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City | SPARTANBURG
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State | SC
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Zip | 29306-3805
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Country | US
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Telephone | 864-560-6217
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Fax | 864-560-6335
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Provider Business Mailing Address
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Address Line | PO BOX 52990
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City | GREENWOOD
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State | SC
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Zip | 29649-0048
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Country | US
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Telephone | 864-223-3600
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Fax | 864-223-6054
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN DAVID WRENN
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Credential | MD
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Telephone | 864-560-6217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) Physician
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License Number | 21725
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 10037
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License Number State | SC
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