Provider Demographics
NPI:1609380278
Name:GRUBBS, SARAH RIDER (MD, MEMBER AAP)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:RIDER
Last Name:GRUBBS
Suffix:
Gender:F
Credentials:MD, MEMBER AAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 PARK VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29617-7939
Mailing Address - Country:US
Mailing Address - Phone:864-246-1070
Mailing Address - Fax:864-246-1070
Practice Address - Street 1:58 PARK VISTA WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29617-7939
Practice Address - Country:US
Practice Address - Phone:864-246-1070
Practice Address - Fax:864-246-1070
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-18
Last Update Date:2017-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10978208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics