Individual
ADWOA A ADU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
877 W FARIS RD, GREENVILLE, SC 29605-4289
(864) 455-7800
(864) 455-9082
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
86590
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
SC
Enumeration date
04/03/2018
Last updated
03/25/2024
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