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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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