Provider Demographics
NPI:1821100835
Name:GROSSLIGHT, SUSAN HAMMOND (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:HAMMOND
Last Name:GROSSLIGHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1218
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-5218
Mailing Address - Country:US
Mailing Address - Phone:803-635-6461
Mailing Address - Fax:803-635-4200
Practice Address - Street 1:880 W MOULTRIE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-2411
Practice Address - Country:US
Practice Address - Phone:803-635-6461
Practice Address - Fax:803-635-4200
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR41098163WC1400X
SC17725207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No163WC1400XNursing Service ProvidersRegistered NurseCollege Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2030Medicaid