Provider Demographics
NPI:1871324814
Name:PIEDMONT PEDIATRICS LLC
Entity type:Organization
Organization Name:PIEDMONT PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-833-5654
Mailing Address - Street 1:996 MEDICAL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-4541
Mailing Address - Country:US
Mailing Address - Phone:864-833-5654
Mailing Address - Fax:864-833-2786
Practice Address - Street 1:414 CROSS ANCHOR RD
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388-2216
Practice Address - Country:US
Practice Address - Phone:864-833-5654
Practice Address - Fax:864-833-2786
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIEDMONT PEDIATRICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health