Provider Demographics
NPI:1932189081
Name:ANESTHESIOLOGY OF GREENWOOD PA
Entity Type:Organization
Organization Name:ANESTHESIOLOGY OF GREENWOOD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-227-8242
Mailing Address - Street 1:PO BOX 742324
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2103
Mailing Address - Country:US
Mailing Address - Phone:706-860-2701
Mailing Address - Fax:706-860-6484
Practice Address - Street 1:1325 SPRING ST
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3860
Practice Address - Country:US
Practice Address - Phone:864-227-4111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0733Medicaid
SC4403Medicare PIN