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General NPI Number Information
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NPI Number | 1750489027
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Entity Type | Organization
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Legal Business Name | GREENWOOD FAMILY PRACTICE, INC.
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 11/30/2017
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Provider Practice Location Address
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Address Line | 805 MONTAGUE AVE STE A
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City | GREENWOOD
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State | SC
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Zip | 29649-1464
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Country | US
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Telephone | 864-223-6621
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Fax | 864-223-6659
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Provider Business Mailing Address
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Address Line | 805 MONTAGUE AVE STE A
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City | GREENWOOD
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State | SC
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Zip | 29649-1464
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Country | US
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Telephone | 864-223-6621
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Fax | 864-223-6659
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Authorized Official
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Title or Position | CEO
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Name | MICHELE GRAHAM
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Credential | RN
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Telephone | 864-223-6621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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