Individual
ALI A LATEFI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
101 E WOOD ST, SPARTANBURG, SC 29303-3040
(864) 585-8221
(864) 542-9859
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
3038
TN
208800000X
Urology Physician
48946
MN
208800000X
Urology Physician
Primary
89687
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
896873
—
SC
01
—
SCQ8263365
MEDICARE PIN
SC
Enumeration date
06/18/2006
Last updated
11/01/2023
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