Organization
CLEMSON NEUROLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA S CLARK (OFFICE MANAGER)
(864) 653-4071
Entity
Organization
Contact information
Practice address
220 KEOWEE TRL, CLEMSON, SC 29631-1448
(864) 653-4071
(864) 653-4074
Mailing address
220 KEOWEE TRL, CLEMSON, SC 29631-1448
(864) 653-4071
(864) 653-4074
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3805
—
SC
Enumeration date
11/01/2005
Last updated
04/20/2008
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