Organization
PRISMA HEALTH UNIVERSITY MEDICAL GROUP
Active
Other names
Clemson-Seneca Pediatrics-Clemson
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTI ANN LAWRENCE (DIRECTOR PROVIDER ENROLLMENT)
(864) 797-6118
Entity
Organization
Contact information
Practice address
208 FRONTAGE RD, SUITE 1, CLEMSON, SC 29631-1691
(864) 654-6034
Mailing address
1 INDEPENDENCE PT STE 212, GREENVILLE, SC 29615-4536
(864) 385-4790
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP7326
—
SC
Enumeration date
07/12/2016
Last updated
05/15/2020
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