Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 2000027634 | SC |
N | 204C00000X | Sports Medicine Doctor | BOC335022 | SC |
NPI | 1588010540 |
---|---|
Provider Name | James Anderson |
First Address | Greer, SC 29650-4380 |
Second Address | Tigerville, SC 29688-9700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2016 |
Last Update Date | 31/12/2020 |