Provider Demographics
NPI:1841243409
Name:KONZ, LADIA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LADIA
Middle Name:M
Last Name:KONZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LADIA
Other - Middle Name:M
Other - Last Name:KOESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:EMERGENCY CENTER
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27304207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC189211OtherMEDCOST
SC7584616OtherAETNA
SC20051875OtherSELECT HEALTH CHOICE
NC89067KWMedicaid
SC273046Medicaid
SC20051875OtherSELECT HEALTH CHOICE
SC189211OtherMEDCOST
SCI20368Medicare UPIN
SCP00316699Medicare PIN
SCAA06759068Medicare PIN
SCI203688510Medicare PIN