Healthcare Provider Details

I. General information

NPI: 1083652630
Provider Name (Legal Business Name): PIEDMONT PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

996 MEDICAL RIDGE ROAD
CLINTON SC
29325
US

IV. Provider business mailing address

996 MEDICAL RIDGE ROAD
CLINTON SC
29325
US

V. Phone/Fax

Practice location:
  • Phone: 864-833-5654
  • Fax: 864-833-2786
Mailing address:
  • Phone: 864-833-5654
  • Fax: 864-833-2786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAREN NOLEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 864-438-3143