| Upstate Wellness Center Llc | |
|
102 Buford Ave Ste A Anderson SC 29621-3365 | |
| (864) 261-9506 | |
| Not Available |
| Full Name | Upstate Wellness Center Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 102 Buford Ave Ste A, Anderson, South Carolina |
| Authorized Official Name and Position | Heather Marshall Ford (CO-OWNER, PROVIDER) |
| Authorized Official Contact | 8649400523 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Upstate Wellness Center Llc 102 Buford Ave Ste A Anderson SC 29621-3365 Ph: (864) 261-9506 | Upstate Wellness Center Llc 102 Buford Ave Ste A Anderson SC 29621-3365 Ph: (864) 261-9506 |
| NPI Number | 1871362459 |
|---|---|
| Provider Enumeration Date | 12/25/2023 |
| Last Update Date | 03/26/2024 |
| Certification Date | 03/26/2024 |
| Medicare PECOS PAC ID | 8527406545 |
|---|---|
| Medicare Enrollment ID | O20240409003803 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871362459 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Ernest Cleage Martin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437176922 PECOS PAC ID: 3971582909 Enrollment ID: I20040714001227 |
| Provider Name | June L Glenn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043568801 PECOS PAC ID: 4385871763 Enrollment ID: I20131210000705 |
| Provider Name | Carissa B Parnell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861826190 PECOS PAC ID: 8527299437 Enrollment ID: I20140318000700 |
| Provider Name | Tracy D Morrison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063826956 PECOS PAC ID: 4981821782 Enrollment ID: I20140818001639 |
| Provider Name | Heather Marshall Ford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174165054 PECOS PAC ID: 0749613909 Enrollment ID: I20191203001028 |
| Provider Name | Tandi W. Fortier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205494580 PECOS PAC ID: 2769897321 Enrollment ID: I20210212002309 |
| Provider Name | Mary Marie Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215637301 PECOS PAC ID: 8022465756 Enrollment ID: I20231116003390 |
| Provider Name | Rosaria L Calhoun |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528426871 PECOS PAC ID: 1759732498 Enrollment ID: I20240108003407 |
| Provider Name | Susan Thrasher Martin |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1215991450 PECOS PAC ID: 7214322700 Enrollment ID: I20240124001447 |
| Provider Name | George L. Jones |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588786073 PECOS PAC ID: 2163875626 Enrollment ID: I20240131003206 |
| Provider Name | Cadyn Liam Burnside |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356846877 PECOS PAC ID: 9537504303 Enrollment ID: I20240302000371 |
| Provider Name | Abigail Turner Shipman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174382097 PECOS PAC ID: 1850730276 Enrollment ID: I20240418001891 |
| Provider Name | Deundra T Cooke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306312517 PECOS PAC ID: 4880036730 Enrollment ID: I20240523003509 |
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