Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 3727 | SC |
NPI | 1013514678 |
---|---|
Provider Name | Jessica Marie Greenwood |
First Address | Charleston, SC 29407-7165 |
Second Address | Charleston, SC 29407-7165 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2020 |
Last Update Date | 08/10/2020 |