Organization
PS121 MANAGEMENT PA
Active
Other names
VIDA GYNECOLOGY
Organization subpart
No
Provider details
NPI number
Authorized official
BRYANNA WYATT (OFFICE MANAGER)
(864) 720-1299
Entity
Organization
Contact information
Practice address
330C PELHAM RD STE A, GREENVILLE, SC 29615-3111
(864) 720-1299
(864) 720-1300
Mailing address
330C PELHAM RD STE A, GREENVILLE, SC 29615-3111
(864) 720-1299
(864) 720-1300
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Enumeration date
07/26/2018
Last updated
05/24/2023
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