# PREMISE HEALTH OF SOUTH CAROLINA MEDICAL, P.C

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DTNA Occ - Gaffney
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144996539
- **Authorized official:** JON LEIZMAN (PRESIDENT)
- **Authorized official phone:** (216) 479-9063

## Contact information

- **Practice address:** 211 WOODLAND RD, GAFFNEY, SC 29341-1055
- **Practice address phone:** (864) 301-8325
- **Practice address fax:** (864) 489-1949
- **Mailing address:** 5500 MARYLAND WAY, BRENTWOOD, TN 37027-7048

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/17/2021
- **Last updated:** 08/23/2022