Individual
TIM LARGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
48 CENTENNIAL WAY, GREENVILLE, SC 29605-4662
(864) 522-8603
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
90657
SC
Other
Enumeration date
06/10/2012
Last updated
08/23/2023
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