Healthcare Provider Details

I. General information

NPI: 1760714927
Provider Name (Legal Business Name): CLIFTON W. STRAUGHN, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E GREENVILLE ST
ANDERSON SC
29621-5535
US

IV. Provider business mailing address

PO BOX 2505 301 E. GREENVILLE STREET
ANDERSON SC
29622-2505
US

V. Phone/Fax

Practice location:
  • Phone: 864-224-5689
  • Fax: 864-225-2349
Mailing address:
  • Phone: 864-224-5689
  • Fax: 864-225-2349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11587
License Number StateSC

VIII. Authorized Official

Name: DR. CLIFTON WADE STRAUGHN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 864-224-5689