MEDICARE: GREENWOOD FAMILY PRACTICE, INC.

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750489027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENWOOD FAMILY PRACTICE, INC.

Provider Business Mailing Address
First Line	:	805 MONTAGUE AVE STE A
Second Line	:
City	:	GREENWOOD
State	:	SC
Zip	:	29649-1464
Country	:	US
Telephone Number	:	864-223-6621
Fax Number	:	864-223-6659

Provider Business Practice Location Address
First Line	:	805 MONTAGUE AVE STE A
Second Line	:
City	:	GREENWOOD
State	:	SC
Zip	:	29649-1464
Country	:	US
Telephone Number	:	864-223-6621
Fax Number	:	864-223-6659

Authorized Official
Title or Position	:	CEO
Name	:	MICHELE GRAHAM
Credential	:	RN
Telephone Number	:	864-223-6621

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	11/30/2017

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