Individual
RONALD CAUDILL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
701 GROVE RD FL 5, GREENVILLE, SC 29605-4210
(864) 455-4411
(864) 455-4480
Mailing address
1 INDEPENDENCE PT STE 212, GREENVILLE, SC 29615-4536
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
22130
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
301100
—
SC
Enumeration date
08/17/2018
Last updated
01/09/2020
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