Provider Demographics
NPI:1396853263
Name:PELIC, CHRISTOPHER G (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:G
Last Name:PELIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 344054
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29634-0001
Mailing Address - Country:US
Mailing Address - Phone:864-656-2233
Mailing Address - Fax:864-656-0760
Practice Address - Street 1:735 MCMILLAN ROAD
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29364-4054
Practice Address - Country:US
Practice Address - Phone:864-656-2233
Practice Address - Fax:864-656-0760
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC228392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC228391Medicaid
I05797Medicare UPIN