Individual
DORENDA GREGG TRUESDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2633 CELANESE RD, ROCK HILL, SC 29732-1205
(803) 329-5131
(803) 366-6600
Mailing address
704 GOLD HILL RD, STE 107, FORT MILL, SC 29715-8907
(803) 329-5131
(803) 366-6600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2006-00615
NC
207Q00000X
Family Medicine Physician
Primary
22650
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
066NX
BLUE CROSS BLUE SHIELD NC
NC
01
—
080195108
RAILROAD MEDICARE
—
05
—
226507
—
SC
Enumeration date
07/16/2006
Last updated
11/09/2016
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