Provider Demographics
NPI:1013330703
Name:GREENVILLE ADHD SPECIALISTS, PA
Entity Type:Organization
Organization Name:GREENVILLE ADHD SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-305-1662
Mailing Address - Street 1:211 E BUTLER RD
Mailing Address - Street 2:SUITE C1
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2169
Mailing Address - Country:US
Mailing Address - Phone:864-305-1662
Mailing Address - Fax:864-603-2067
Practice Address - Street 1:211 E BUTLER RD STE C1
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662
Practice Address - Country:US
Practice Address - Phone:864-305-1662
Practice Address - Fax:864-603-2067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28013207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP6422Medicaid
SC280136Medicaid
D08060Medicare UPIN
SC280136Medicaid