Provider Demographics
NPI:1447984786
Name:ZIMMERMAN, TEQUILA (CPT-NCCT)
Entity type:Individual
Prefix:
First Name:TEQUILA
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:CPT-NCCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-4497
Mailing Address - Country:US
Mailing Address - Phone:864-323-9519
Mailing Address - Fax:
Practice Address - Street 1:503 CROSS ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4497
Practice Address - Country:US
Practice Address - Phone:864-323-9519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy