Provider Demographics
NPI:1578097812
Name:SNOW, GRETA ELIZABETH (DO)
Entity Type:Individual
Prefix:
First Name:GRETA
Middle Name:ELIZABETH
Last Name:SNOW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 HOUSTON NORTHCUTT BLVD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3448
Mailing Address - Country:US
Mailing Address - Phone:843-408-0092
Mailing Address - Fax:
Practice Address - Street 1:917 HOUSTON NORTHCUTT BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3448
Practice Address - Country:US
Practice Address - Phone:843-408-0092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC83558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program