Provider Demographics
NPI:1538698030
Name:ANDERSON, DEBORAH TEMPLES (FNP-C)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:TEMPLES
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:LEE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:11 DOCTORS PARK DR STE 220
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1008
Practice Address - Country:US
Practice Address - Phone:864-253-8055
Practice Address - Fax:864-253-8126
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20905363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCB3943365OtherMEDICARE PIN
SCSCB3944746OtherMEDICARE PIN
SCNP4916Medicaid
SCSCB3945019OtherMEDICARE PIN