Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 83292 | SC |
NPI | 1003251166 |
---|---|
Provider Name | Dr. Andre C Eaddy |
First Address | Greenville, SC 29601-2842 |
Second Address | Greenville, SC 29605-4285 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2013 |
Last Update Date | 04/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
832923 | (05) | SC |