Provider Demographics
NPI:1194984476
Name:PRZYBYLA, ADAM GREGORY (MD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:GREGORY
Last Name:PRZYBYLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:115 N SUMTER ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4972
Practice Address - Country:US
Practice Address - Phone:803-775-1550
Practice Address - Fax:803-775-7258
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30833208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC308330Medicaid
SC308330Medicaid
SCSC1266F694Medicare PIN