Provider Demographics
NPI:1841742889
Name:GREENVILLE MEDICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:GREENVILLE MEDICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVEEN
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:BETHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-901-5876
Mailing Address - Street 1:545 W BUTLER RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4833
Mailing Address - Country:US
Mailing Address - Phone:864-299-1990
Mailing Address - Fax:864-299-9123
Practice Address - Street 1:545 W BUTLER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4833
Practice Address - Country:US
Practice Address - Phone:864-299-1990
Practice Address - Fax:864-299-9123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20540207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAPRN 20540OtherSC STATE LICENSE