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Organization
UPSTATE CAROLINA MEDICAL LLC
Active
Organization
UPSTATE CAROLINA MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA VASSALLO (OWNER/ NURSE PRACTITIONER)
(864) 903-9604
Entity
Organization
Contact information
Practice address
144 THOMAS GREEN BLVD STE 232, CLEMSON, SC 29631-2291
(864) 722-5203
(864) 722-5203
Mailing address
144 THOMAS GREEN BLVD STE 232, CLEMSON, SC 29631-2291
(864) 722-5203
(864) 722-5203
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/14/2022
Last updated
06/01/2022
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