Provider Demographics
NPI:1558311761
Name:PIEDMONT HEALTH GROUP, LLC
Entity Type:Organization
Organization Name:PIEDMONT HEALTH GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-227-5240
Mailing Address - Street 1:PO BOX 1136
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29648-1136
Mailing Address - Country:US
Mailing Address - Phone:864-227-5240
Mailing Address - Fax:864-227-5239
Practice Address - Street 1:303 W ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4046
Practice Address - Country:US
Practice Address - Phone:864-227-5240
Practice Address - Fax:864-227-5239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18466174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF95780Medicare UPIN
SC7200Medicare ID - Type UnspecifiedGROUP NUMBER
SCG29638Medicare UPIN