Basic Information
Provider Information
NPI: 1558650556
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MEHTA
FirstName: NAVINA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 INDEPENDENCE PT STE 212
Address2:  
City: GREENVILLE
State: SC
PostalCode: 296154536
CountryCode: US
TelephoneNumber: 8647976308
FaxNumber: 8646279301
Practice Location
Address1: 325 MEDICAL PKWY STE 200
Address2:  
City: GREER
State: SC
PostalCode: 296502457
CountryCode: US
TelephoneNumber: 8647979550
FaxNumber: 8647979555
Other Information
ProviderEnumerationDate: 03/31/2011
LastUpdateDate: 01/03/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X52179SCY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


Home