| Genesis Lifestyle Medicine | |
|
108 Commons Blvd Ste A Piedmont SC 29673-7766 | |
| (864) 940-3682 | |
| Not Available |
| Full Name | Genesis Lifestyle Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 108 Commons Blvd Ste A, Piedmont, South Carolina |
| Authorized Official Name and Position | Alex Spinoso (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 8649403682 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Lifestyle Medicine 108 Commons Blvd Ste A Piedmont SC 29673-7766 Ph: (864) 940-3682 | Genesis Lifestyle Medicine 108 Commons Blvd Ste A Piedmont SC 29673-7766 Ph: (864) 940-3682 |
| NPI Number | 1801495841 |
|---|---|
| Provider Enumeration Date | 10/21/2020 |
| Last Update Date | 11/20/2020 |
| Medicare PECOS PAC ID | 1052722071 |
|---|---|
| Medicare Enrollment ID | O20201124000830 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801495841 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Bradley Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528626041 PECOS PAC ID: 6103252002 Enrollment ID: I20200213001390 |
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