Healthcare Provider Details

I. General information

NPI: 1407685506
Provider Name (Legal Business Name): PIEDMONT PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

996 MEDICAL RIDGE RD
CLINTON SC
29325-4541
US

IV. Provider business mailing address

996 MEDICAL RIDGE RD
CLINTON SC
29325-4541
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

VIII. Authorized Official

Name: KAREN NOLEN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 864-833-5654