Organization
FOOTHILLS UROLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY K NICKLES MBA (OFFICE MANAGER)
(864) 855-6811
Entity
Organization
Contact information
Practice address
403 HILLCREST DR, SUITE A, EASLEY, SC 29640-1207
(864) 855-6811
(864) 855-6784
Mailing address
PO BOX 1793, EASLEY, SC 29641-1793
(864) 855-6811
(864) 855-6784
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
7514
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP0270
—
SC
Enumeration date
03/26/2008
Last updated
03/26/2008
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