Provider Demographics
NPI:1821611427
Name:NABORS, ETTA GRACE (DO)
Entity Type:Individual
Prefix:
First Name:ETTA
Middle Name:GRACE
Last Name:NABORS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 GROVE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4210
Mailing Address - Country:US
Mailing Address - Phone:864-455-7895
Mailing Address - Fax:864-455-7807
Practice Address - Street 1:701 GROVE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4210
Practice Address - Country:US
Practice Address - Phone:864-455-7895
Practice Address - Fax:864-455-7807
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-01054208000000X
SCLL83159208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics