Individual
MRS. JATHA JOHN MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
701 GROVE RD FL 5, GREENVILLE, SC 29605-4295
(864) 455-4411
(864) 455-4480
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
22785
SC
363LF0000X
Family Nurse Practitioner
Primary
22785
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP6128
—
SC
Enumeration date
06/26/2019
Last updated
07/28/2021
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