Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 17998 | SC |
NPI | 1215985874 |
---|---|
Provider Name | Charles William Greene JR. |
First Address | Greenville, SC 29607 |
Second Address | Greenville, SC 29607-2778 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 18/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
179988 | (05) | SC |
5296584 | AETNA (01) | SC |
576007863127 | BLUE CHOICE OF SC (01) | SC |
576007863131 | BCBS OF SC (01) | SC |
9212323 | CIGNA (01) | SC |
G21093 | (02) | SC |