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Organization
PRISMA HEALTH UNIVERSITY MEDICAL GROUP
Active
Organization
PRISMA HEALTH UNIVERSITY MEDICAL GROUP
Active
Other names
PH Developmental Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTI ANN LAWRENCE (DIRECTOR PROVIDER ENROLLMENT & CVO)
(864) 522-8611
Entity
Organization
Contact information
Practice address
200 PATEWOOD DR, SUITE A200, GREENVILLE, SC 29615-3593
(864) 454-5115
Mailing address
7 INDEPENDENCE PT STE 140, GREENVILLE, SC 29615-4550
(864) 385-4790
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20032744
SELECT HEALTH ID NUMBER
SC
05
—
DEC300
—
SC
05
—
DRC010
—
SC
Enumeration date
11/17/2009
Last updated
02/23/2024
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