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Organization
OTIS BOYD GARDO JR
Active
Organization
OTIS BOYD GARDO JR
Active
Other names
HIGHLANDS ANAPLASTOLOGY ASSOCIATES
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. REBECCA J. GARDO (OFFICE MANAGER)
(864) 232-3008
Entity
Organization
Contact information
Practice address
1007 GROVE RD, SUITE E, GREENVILLE, SC 29605-4630
(864) 232-3008
(864) 845-8556
Mailing address
126 COOL MEADOWS DR, PIEDMONT, SC 29673-8941
(864) 232-3008
(864) 845-8556
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
530923946B
—
GA
05
—
7704873
—
NC
05
—
DE2711
—
SC
Enumeration date
02/11/2008
Last updated
02/03/2009
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