Individual
DENISE MICHELLE MATHIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2660 REIDVILLE RD UNIT 1, SPARTANBURG, SC 29301-3512
(864) 560-9696
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
18111
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP2242
—
SC
01
—
P01190556
RAILROAD MEDICARE
SC
01
—
SC04416067
MEDICARE PIN
SC
Enumeration date
01/03/2013
Last updated
10/10/2019
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