Provider Demographics
NPI:1063476588
Name:ROSS, JOSEPH PAUL III (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PAUL
Last Name:ROSS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:100 E WOOD ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3004
Practice Address - Country:US
Practice Address - Phone:864-560-7070
Practice Address - Fax:864-560-7073
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC18710208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC88350OtherMEDCOST
SC187103Medicaid
SC5152703OtherAETNA
NC690562VMedicaid
SCG870807628OtherMEDICARE PIN
SCG87080Medicare PIN
SCP00335474Medicare PIN
SCG87080Medicare UPIN