Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0204X | Pediatric Emergency Doctor | 030863 | GA |
Y | 2080P0204X | Pediatric Emergency Doctor | 35199 | SC |
NPI | 1053374983 |
---|---|
Provider Name | Janice Lee Rea |
First Address | Greenville, SC 29615-4545 |
Second Address | Greenville, SC 29605-4267 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 13/06/2013 |