Provider Demographics
NPI:1801807011
Name:METZNER - SADURSKI, JOANNA K (MD)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:K
Last Name:METZNER - SADURSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:K
Other - Last Name:SADURSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1325 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3860
Mailing Address - Country:US
Mailing Address - Phone:864-725-7100
Mailing Address - Fax:864-725-7101
Practice Address - Street 1:1325 SPRING ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3860
Practice Address - Country:US
Practice Address - Phone:864-725-7100
Practice Address - Fax:864-725-7101
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21428207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC214280Medicaid
SC214280Medicaid
SCH62875Medicare UPIN
SC9337Medicare PIN
SCGP5432Medicaid