Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 16395 | SC |
NPI | 1013927334 |
---|---|
Provider Name | Chacko John |
First Address | Greenwood, SC 29646-3860 |
Second Address | Greenwood, SC 29646-3860 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 10/12/2021 |