Individual
LEEANNE JONES GRUMELOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
200 PATEWOOD DR STE B480, GREENVILLE, SC 29615-6327
(864) 454-4570
(864) 454-4575
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
855
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1525PA
—
SC
01
—
855
SC BOARD OF MEDICAL EXAMI
SC
Enumeration date
06/09/2006
Last updated
05/01/2023
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