Basic Information
Provider Information
NPI: 1487636999
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PORTER
FirstName: JOHN
MiddleName: A
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 131 COMMONWEALTH DR STE 240
Address2:  
City: GREENVILLE
State: SC
PostalCode: 296155194
CountryCode: US
TelephoneNumber: 8645161170
FaxNumber: 8772499483
Practice Location
Address1: 3 SAINT FRANCIS DR STE 330
Address2:  
City: GREENVILLE
State: SC
PostalCode: 296013972
CountryCode: US
TelephoneNumber: 8645161170
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/18/2005
LastUpdateDate: 07/24/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0400X51877SCY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

No ID Information.


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