# PRISMA HEALTH UNIVERSITY MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PRISMA HEALTH UNIVERSITY MEDICAL GROUP
- **Other names:** PH Diabetes Prevention Program - Upstate, PH Diabetes Prevention Program-Upstate
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1114542081
- **Legal business name:** PRISMA HEALTH UNIVERSITY MEDICAL GROUP
- **Authorized official:** KRISTI ANN LAWRENCE (DIRECTOR)
- **Authorized official phone:** (864) 385-4790

## Contact information

- **Practice address:** 712 GROVE RD, GREENVILLE, SC 29605-4211
- **Practice address phone:** (864) 522-1439
- **Practice address fax:** (864) 522-1428
- **Mailing address:** 1 INDEPENDENCE PT STE 212, GREENVILLE, SC 29615-4536

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174H00000X | Health Educator | — | NULL | Yes |
| 174H00000X | Health Educator | — | — | Yes |

## Other

- **Enumeration date:** 06/16/2020
- **Last updated:** 06/16/2020