Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 38342 | SC |
N | 207Q00000X | Family Doctor | 80885 | GA |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 38342 | SC |
NPI | 1235511742 |
---|---|
Provider Name | Antigone Childs |
First Address | Greenville, SC 29601-2842 |
Second Address | Seneca, SC 29678-1142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2015 |
Last Update Date | 06/05/2021 |