Provider Demographics
NPI:1821401233
Name:YURCISIN, GEOFFREY HUNTER (MD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:HUNTER
Last Name:YURCISIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:864-797-6311
Mailing Address - Fax:
Practice Address - Street 1:103 OMNI DR STE B
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-9448
Practice Address - Country:US
Practice Address - Phone:864-886-9250
Practice Address - Fax:864-886-9251
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL35877208600000X
SC36877208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery