Provider Demographics
NPI:1497578108
Name:PHIFER GREEN, ANDREAU LYNN (MED)
Entity type:Individual
Prefix:
First Name:ANDREAU
Middle Name:LYNN
Last Name:PHIFER GREEN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BROOKDALE DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3141
Mailing Address - Country:US
Mailing Address - Phone:864-266-6117
Mailing Address - Fax:
Practice Address - Street 1:500 BROOKDALE DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3141
Practice Address - Country:US
Practice Address - Phone:864-266-6117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care