Basic Information
| Provider Information | |||||||||
| NPI: | 1659304483 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BISHOP | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 MONUMENT ST | ||||||||
| Address2: | SUITE 224 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296462638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642273908 | ||||||||
| FaxNumber: | 8642272668 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 MONUMENT ST | ||||||||
| Address2: | SUITE 224 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296462638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642273908 | ||||||||
| FaxNumber: | 8642272668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 08/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 20-22069 | SC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | N01253 | 05 | SC | MEDICAID |