| NPI | 1053605196 |
|---|---|
| Doing Business As | PROVIDENCE FAMILY MEDICINE CLEMSON ROAD |
| Entity Type | Organization |
| Authorized Contact | ANGELA HAITHCOCK Credentialing COO Rdinator 803-865-4780 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2011-06-07 |