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Organization

UPSTATE CAROLINA MEDICAL LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JESSICA VASSALLO (OWNER/ NURSE PRACTITIONER)
(864) 903-9604
Entity
Organization

Contact information

Practice address
144 THOMAS GREEN BLVD STE 232, CLEMSON, SC 29631-2291
(864) 722-5203
(864) 722-5203
Mailing address
144 THOMAS GREEN BLVD STE 232, CLEMSON, SC 29631-2291
(864) 722-5203
(864) 722-5203

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary

Other

Enumeration date
01/14/2022
Last updated
06/01/2022
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