Provider Demographics
NPI:1992833719
Name:PIEDMONT REPRODUCTIVE ENDOCRINOLOGY GROUP, PA
Entity Type:Organization
Organization Name:PIEDMONT REPRODUCTIVE ENDOCRINOLOGY GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:864-232-7734
Mailing Address - Street 1:17 CALEDON COURT
Mailing Address - Street 2:SUITE C
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29165
Mailing Address - Country:US
Mailing Address - Phone:864-232-7734
Mailing Address - Fax:864-232-7099
Practice Address - Street 1:17 CALEDON CT
Practice Address - Street 2:SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29165
Practice Address - Country:US
Practice Address - Phone:864-232-7734
Practice Address - Fax:864-232-7099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty