Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 83883 | SC |
NPI | 1013303627 |
---|---|
Provider Name | Gregory Fredrick Hertwig |
First Address | Columbus, GA 31902-2545 |
Second Address | Spartanburg, SC 29303-3040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2015 |
Last Update Date | 24/07/2020 |