Healthcare Provider Details

I. General information

NPI: 1740107325
Provider Name (Legal Business Name): PHYSICIAN SERVICES GROUP OF SOUTH CAROLINA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BENTZ RD
PIEDMONT SC
29673-1412
US

IV. Provider business mailing address

312 SUMMERALL DR
ANDERSON SC
29621-3697
US

V. Phone/Fax

Practice location:
  • Phone: 864-845-5177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: CHARITY DAWN FITZSIMMONS
Title or Position: NURSE PRACTITIONER
Credential: DNP, APRN, FNP-C
Phone: 817-914-4686