Provider Demographics
NPI:1073584769
Name:FOOTHILLS RHEUMATOLOGY
Entity Type:Organization
Organization Name:FOOTHILLS RHEUMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:M
Authorized Official - Last Name:AGHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-716-6030
Mailing Address - Street 1:PO BOX 24123
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-4123
Mailing Address - Country:US
Mailing Address - Phone:864-254-0205
Mailing Address - Fax:864-254-0309
Practice Address - Street 1:2000 E GREENVILLE ST
Practice Address - Street 2:SUITE 2700
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1580
Practice Address - Country:US
Practice Address - Phone:864-716-6030
Practice Address - Fax:864-716-6039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2344Medicaid
SCGP2344Medicaid