Provider Demographics
NPI:1124540331
Name:ENLOE, AMY ROBERTSON
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ROBERTSON
Last Name:ENLOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 OAKLAWN RD
Mailing Address - Street 2:
Mailing Address - City:PELZER
Mailing Address - State:SC
Mailing Address - Zip Code:29669-9363
Mailing Address - Country:US
Mailing Address - Phone:864-243-4700
Mailing Address - Fax:864-243-4100
Practice Address - Street 1:430 OAKLAWN RD
Practice Address - Street 2:
Practice Address - City:PELZER
Practice Address - State:SC
Practice Address - Zip Code:29669-9363
Practice Address - Country:US
Practice Address - Phone:864-243-4700
Practice Address - Fax:864-243-4100
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0337068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine