Individual
DR. VONDA K GRAVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
250 DEWEY AVE, SPARTANBURG, SC 29303-3009
(864) 585-0366
Mailing address
124 MALLARD ST, GREENVILLE, SC 29601-4046
(864) 241-1040
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
21107
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
211078
—
SC
05
—
5905213
—
NC
01
—
C7069
MEDCOST
SC
Enumeration date
01/27/2006
Last updated
03/09/2020
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