Healthcare Provider Details

I. General information

NPI: 1053917757
Provider Name (Legal Business Name): TIGER PEDIATRICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4741 HIGHWAY 153 STE A
EASLEY SC
29642-9161
US

IV. Provider business mailing address

4741 HIGHWAY 153 STE A
EASLEY SC
29642-9161
US

V. Phone/Fax

Practice location:
  • Phone: 864-661-5278
  • Fax:
Mailing address:
  • Phone: 864-661-5278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KRISTIE LEIGH BRAGG
Title or Position: PRESIDENT
Credential: MD
Phone: 864-661-5278