Organization
PRISMA HEALTH UNIVERSITY MEDICAL GROUP
Active
Other names
PH Developmental Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTI ANN LAWRENCE (DIRECTOR PROVIDER ENROLLMENT & CVO)
(864) 522-8611
Entity
Organization
Contact information
Practice address
200 PATEWOOD DR, SUITE A200, GREENVILLE, SC 29615-3593
(864) 454-5115
Mailing address
7 INDEPENDENCE PT STE 140, GREENVILLE, SC 29615-4550
(864) 385-4790
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20032744
SELECT HEALTH ID NUMBER
SC
05
—
DEC300
—
SC
05
—
DRC010
—
SC
Enumeration date
11/17/2009
Last updated
02/23/2024
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