Provider Information for 1902270523
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SCOTT EDWARD GREEN
Sex: Male
NPI: 1902270523
Last Updated: 2024-02-26
Certification Date: 2024-02-26
Certification Date: 2024-02-26
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1902270523 | ||||||||||||
| Enumeration Date | 2015-11-19 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 314 E HAMPTON AVE HONEA PATH, SC 29654-2308 United States Phone: 606-340-0513 | Fax: | ||||||||||||
| Primary Practice Address | 4400 AIRLINE RD ANDERSON, SC 29624-7624 United States Phone: 864-340-0513 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 1824 E MAIN ST | ||||||||||||
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