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Organization
PRISMA HEALTH UNIVERSITY MEDICAL GROUP
Active
Organization
PRISMA HEALTH UNIVERSITY MEDICAL GROUP
Active
Other names
Eastside Pediatrics, PA
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTI ANN LAWRENCE (DIRECTOR)
(864) 522-8611
Entity
Organization
Contact information
Practice address
4501 OLD SPARTANBURG RD STE 9, TAYLORS, SC 29687-4105
(864) 292-8868
(864) 268-9564
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
NULL
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP0576
—
SC
Enumeration date
08/11/2022
Last updated
08/29/2022
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