Most Relevant Information
Provider Data
| NPI Number: | 1003500265 |
| Provider Name: | PRUDENCE MARTIN |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/08/2023 |
| Last Updated: | 06/08/2023 |
Provider Practice Location
25 WOODS LAKE RD STE 712
GREENVILLE
SC
296072765
Practice Location Phone/Fax
| Phone: | 8642420005 |
| Fax: |
Provider Mailing Location
104 MEILLAND DR
GREER
SC
296504421
Provider Mailing Phone/Fax
| Phone: | 8644447959 |
| Fax: |