Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 83142 | SC |
NPI | 1063805992 |
---|---|
Provider Name | Zachary Griggs |
First Address | Columbia, SC 29202-3174 |
Second Address | Anderson, SC 29621-2062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2015 |
Last Update Date | 30/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
83142 | MEDICAL LICENSE (01) | SC |