Organization
ECP SOUTH CAROLINA, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN GLEESON-WARREN (DIRECTOR OF CREDENTIALING)
(864) 412-0446
Entity
Organization
Contact information
Practice address
504 HUNTINGTON RD, GREENVILLE, SC 29615-4212
(864) 412-0446
Mailing address
PO BOX 896129, CHARLOTTE, NC 28289-6129
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093146466
—
NC
05
—
GP6356
—
SC
Enumeration date
12/10/2013
Last updated
12/08/2014
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