MEDICARE: GRETA ELIZABETH SNOW DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	83558	SC

General Provider Information

NPI Number	:	1578097812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETA ELIZABETH SNOW DO

Provider Business Mailing Address
First Line	:	917 HOUSTON NORTHCUTT BLVD
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3448
Country	:	US
Telephone Number	:	843-408-0092
Fax Number	:

Provider Business Practice Location Address
First Line	:	917 HOUSTON NORTHCUTT BLVD
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3448
Country	:	US
Telephone Number	:	843-408-0092
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2017
Last Update Date	:	07/01/2021

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