Healthcare Provider Details

I. General information

NPI: 1669476321
Provider Name (Legal Business Name): HENRY D. SALTER III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 MCMILLAN RD
CLEMSON SC
29634-4054
US

IV. Provider business mailing address

BOX 344054
CLEMSON SC
29634-0001
US

V. Phone/Fax

Practice location:
  • Phone: 864-656-2233
  • Fax: 864-656-0760
Mailing address:
  • Phone: 864-656-2233
  • Fax: 864-656-0760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number13668
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13668
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: