# UPSTATE PODIATRY GROUP, PA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** UPSTATE PODIATRY GROUP, PA
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1396487336
- **Legal business name:** UPSTATE PODIATRY GROUP, PA
- **Authorized official:** STEPHANIE RIDDLE (CFO)
- **Authorized official phone:** (864) 979-3635

## Contact information

- **Practice address:** 1420 JOHN B WHITE SR BLVD, SPARTANBURG, SC 29306-3927
- **Practice address phone:** (864) 399-9070
- **Mailing address:** 801 SE MAIN ST, SIMPSONVILLE, SC 29681-7150
- **Mailing address phone:** (864) 399-9070

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |

## Other

- **Enumeration date:** 04/11/2022
- **Last updated:** 04/13/2022