Provider Demographics
NPI:1750489027
Name:GREENWOOD FAMILY PRACTICE, INC.
Entity Type:Organization
Organization Name:GREENWOOD FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:864-223-6621
Mailing Address - Street 1:805 MONTAGUE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-1464
Mailing Address - Country:US
Mailing Address - Phone:864-223-6621
Mailing Address - Fax:864-223-6659
Practice Address - Street 1:805 MONTAGUE AVE STE A
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-1464
Practice Address - Country:US
Practice Address - Phone:864-223-6621
Practice Address - Fax:864-223-6659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3760Medicaid
SC7764Medicare PIN