Provider Demographics
NPI:1699831321
Name:PIEDMONT CHILDRENS CLINIC
Entity Type:Organization
Organization Name:PIEDMONT CHILDRENS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-222-1891
Mailing Address - Street 1:2000 E GREENVILLE ST
Mailing Address - Street 2:SUITE 4700
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621
Mailing Address - Country:US
Mailing Address - Phone:864-222-1891
Mailing Address - Fax:864-716-6172
Practice Address - Street 1:2000 E GREENVILLE ST
Practice Address - Street 2:SUITE 4700
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621
Practice Address - Country:US
Practice Address - Phone:864-222-1891
Practice Address - Fax:864-716-6172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2009Medicaid