Provider Demographics
NPI:1871958280
Name:ILES, GREGORY SCOTT (PA-C)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:SCOTT
Last Name:ILES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 COMMONWEALTH DR STE 120
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4881
Mailing Address - Country:US
Mailing Address - Phone:864-675-4600
Mailing Address - Fax:
Practice Address - Street 1:135 COMMONWEALTH DR STE 120
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4881
Practice Address - Country:US
Practice Address - Phone:864-675-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5182363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant