Provider Demographics
NPI:1629258827
Name:SAAD UPSTATE NEUROLOGY, P.A.
Entity Type:Organization
Organization Name:SAAD UPSTATE NEUROLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-542-8713
Mailing Address - Street 1:PO BOX 877
Mailing Address - Street 2:
Mailing Address - City:DRAYTON
Mailing Address - State:SC
Mailing Address - Zip Code:29333-0718
Mailing Address - Country:US
Mailing Address - Phone:864-542-8713
Mailing Address - Fax:864-278-7900
Practice Address - Street 1:100 WILLOW LN
Practice Address - Street 2:SUITE A
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1365
Practice Address - Country:US
Practice Address - Phone:864-542-8713
Practice Address - Fax:864-278-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18351174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2019Medicaid
SC5710Medicare PIN
SCGP2019Medicaid