# CLEMSON/SENECA PEDIATRICS AND ADOLESCENT MEDICINE, P.A.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821090689
- **Authorized official:** MR. LISA CRANE C.N.A. (INSURANCE MANAGER)
- **Authorized official phone:** (864) 888-4222

## Contact information

- **Practice address:** 207 MAIN ST, SENECA, SC 29678-3245
- **Practice address phone:** (864) 888-4222
- **Practice address fax:** (864) 888-0023
- **Mailing address:** 207 MAIN ST, SENECA, SC 29678-3245
- **Mailing address phone:** (864) 888-4222
- **Mailing address fax:** (864) 888-0023

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | 10252 | SC | Yes |

## Other

- **Enumeration date:** 08/11/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | RHC115 | — | SC |