Organization
UPSTATE FAMILY MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE NELSON (DO)
(864) 226-1899
Entity
Organization
Contact information
Practice address
1517 N FANT ST, ANDERSON, SC 29621-4707
(864) 226-1899
(864) 226-5847
Mailing address
1517 N FANT ST, ANDERSON, SC 29621-4707
(864) 226-1899
(864) 226-5847
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3691
—
SC
Enumeration date
05/11/2006
Last updated
03/14/2008
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