Healthcare Provider Details

I. General information

NPI: 1871800219
Provider Name (Legal Business Name): CLEMSON UNIVERSITY JOSEPH F. SULLIVAN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 EPSILON ZETA DR 101 EDWARDS HALL
CLEMSON SC
29634-0001
US

IV. Provider business mailing address

201 EPSILON ZETA DR 101 EDWARDS HALL
CLEMSON SC
29634-0001
US

V. Phone/Fax

Practice location:
  • Phone: 864-656-3076
  • Fax:
Mailing address:
  • Phone: 864-656-3076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberAPN.4212 APRN
License Number StateSC

VIII. Authorized Official

Name: DORIS R. HELMS
Title or Position: PROVOST
Credential:
Phone: 864-656-3243