Provider Demographics
NPI:1003404450
Name:NORTH GREENVILLE UNIVERSITY
Entity Type:Organization
Organization Name:NORTH GREENVILLE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPORTS MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:ATC
Authorized Official - Phone:864-867-4677
Mailing Address - Street 1:7801 N TIGERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TIGERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29688-9700
Mailing Address - Country:US
Mailing Address - Phone:864-867-4677
Mailing Address - Fax:
Practice Address - Street 1:7801 N TIGERVILLE RD
Practice Address - Street 2:
Practice Address - City:TIGERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29688-9700
Practice Address - Country:US
Practice Address - Phone:864-867-4677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty