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Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
48 CENTENNIAL WAY, GREENVILLE, SC 29605-4662
(864) 522-8000
Mailing address
48 CENTENNIAL WAY, GREENVILLE, SC 29605-4662
(864) 522-8000

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
BP10090030
TX
208800000X
Urology Physician
Primary
LL97494
SC

Other

Enumeration date
06/07/2024
Last updated
07/15/2026
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