Basic Information
| Provider Information | |||||||||
| NPI: | 1841819182 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREENVILLE RHEUMATOLOGY & ALLERGY | ||||||||
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| OtherOrganizationName: | GREENVILLE RHEUMATOLOGY & ALLERGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2104A WOODRUFF RD | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296075941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8643362323 | ||||||||
| FaxNumber: | 8643362323 | ||||||||
| Practice Location | |||||||||
| Address1: | 2104A WOODRUFF RD | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296075941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8643362323 | ||||||||
| FaxNumber: | 8643362323 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2020 | ||||||||
| LastUpdateDate: | 08/20/2020 | ||||||||
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| AuthorizedOfficialLastName: | EZEALAH | ||||||||
| AuthorizedOfficialFirstName: | EZINMA | ||||||||
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| AuthorizedOfficialTitleorPosition: | RHEUMATOLOGIST & ALLERGIST | ||||||||
| AuthorizedOfficialTelephone: | 8643362323 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD, MPH | ||||||||
| NPICertificationDate: | 08/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology | 207RR0500X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.