Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | A553 | SC |
NPI | 1679574370 |
---|---|
Provider Name | Candace A Cothran |
First Address | Greenville, SC 29616-2129 |
Second Address | Greenville, SC 29607-5910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 08/07/2007 |