# PREMISE HEALTH OF SOUTH CAROLINA MEDICAL, P.C

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Adidas SPG Health Center DC2
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407586019
- **Authorized official:** JONATHAN LEIZMAN MD (DIRECTOR)
- **Authorized official phone:** (216) 479-9063

## Contact information

- **Practice address:** 670 FALLING CREEK RD, SPARTANBURG, SC 29301-1063
- **Practice address phone:** (615) 468-3188
- **Mailing address:** 5500 MARYLAND WAY STE 120, BRENTWOOD, TN 37027-4993

## Taxonomy

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

## Other

- **Enumeration date:** 06/15/2022
- **Last updated:** 08/23/2022