# PRISMA HEALTH UNIVERSITY MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Clemson-Seneca Pediatrics-Clemson
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225480486
- **Authorized official:** KRISTI ANN LAWRENCE (DIRECTOR PROVIDER ENROLLMENT)
- **Authorized official phone:** (864) 797-6118

## Contact information

- **Practice address:** 208 FRONTAGE RD, SUITE 1, CLEMSON, SC 29631-1691
- **Practice address phone:** (864) 654-6034
- **Mailing address:** 1 INDEPENDENCE PT STE 212, GREENVILLE, SC 29615-4536
- **Mailing address phone:** (864) 385-4790

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | — | NULL | Yes |
| 208000000X | Pediatrics Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/12/2016
- **Last updated:** 05/15/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GP7326 | — | SC |