Provider Demographics
NPI:1164626875
Name:DEMBLA, GEETIKA (MD)
Entity Type:Individual
Prefix:
First Name:GEETIKA
Middle Name:
Last Name:DEMBLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 E PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-4815
Mailing Address - Country:US
Mailing Address - Phone:864-235-2335
Mailing Address - Fax:
Practice Address - Street 1:2700 E PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4815
Practice Address - Country:US
Practice Address - Phone:864-235-2335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA204062208600000X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2126857Medicaid
LA4P643F600OtherMEDICACRE - PTAN