| |
105 Buford Ave Anderson SC 29621-3313 | |
(864) 375-9090 | |
(864) 260-0194 |
Full Name | |
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Speciality | Family Medicine |
Location | 105 Buford Ave, Anderson, South Carolina |
Authorized Official Name and Position | Christine Pearson (VP/CFO) |
Authorized Official Contact | 8645121109 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 100174 Columbia SC 29202-3174 Ph: (864) 375-9090 | 105 Buford Ave Anderson SC 29621-3313 Ph: (864) 375-9090 |
NPI Number | 1225399595 |
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Provider Enumeration Date | 06/04/2012 |
Last Update Date | 09/16/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1225399595 | NPI | - | NPPES |
GP5927 | Medicaid | SC | |
DT0100 | Other | SC | RR MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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