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General NPI Number Information
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NPI Number | 1922045103
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Entity Type | Organization
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Legal Business Name | NETWORK GERIATRIC SERVICES, PA
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 12/22/2009
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Provider Practice Location Address
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Address Line | 103 S PINE ST
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City | SPARTANBURG
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State | SC
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Zip | 29302-1972
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Country | US
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Telephone | 864-327-1510
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Fax | 864-327-1662
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Provider Business Mailing Address
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Address Line | 103 S PINE ST
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City | SPARTANBURG
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State | SC
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Zip | 29302-1972
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Country | US
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Telephone | 864-327-1510
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Fax | 864-327-1662
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Authorized Official
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Title or Position | CEO
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Name | DR. ROY BRADFORD WHITNEY
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Credential | M.D.
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Telephone | 864-327-1510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 12758
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License Number State | SC
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