# GREENVILLE FUNCTIONAL MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033545595
- **Authorized official:** VICKIE ROBBINS (TEAM LEADER)
- **Authorized official phone:** (864) 558-0200

## Contact information

- **Practice address:** 301 HALTON RD, SUITE A, GREENVILLE, SC 29607-3496
- **Practice address phone:** (864) 558-0200
- **Practice address fax:** (864) 520-1245
- **Mailing address:** 301 HALTON RD, SUITE A, GREENVILLE, SC 29607-3496
- **Mailing address phone:** (864) 558-0200
- **Mailing address fax:** (864) 520-1245

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 14652 | SC | Yes |

## Other

- **Enumeration date:** 09/16/2013
- **Last updated:** 09/16/2013