Organization
FOOTHILLS INTERNAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA WATERS (ADMINISTRATOR)
(864) 855-1331
Entity
Organization
Contact information
Practice address
1648 GENTRY MEMORIAL HWY, EASLEY, SC 29640-8877
(864) 855-1331
(864) 855-1602
Mailing address
1648 GENTRY MEMORIAL HWY, EASLEY, SC 29640-8877
(864) 855-1331
(864) 855-1602
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP0069
—
SC
Enumeration date
09/14/2005
Last updated
09/26/2008
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