Provider Demographics
NPI:1144697384
Name:PRICE, CLINT (APRN)
Entity type:Individual
Prefix:
First Name:CLINT
Middle Name:
Last Name:PRICE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PHIFER DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3909
Mailing Address - Country:US
Mailing Address - Phone:864-621-2234
Mailing Address - Fax:
Practice Address - Street 1:2030 NORTH CHURCH STREET
Practice Address - Street 2:LUNG AND CHEST MEDICAL ASSOCIATES
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3909
Practice Address - Country:US
Practice Address - Phone:864-582-6858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19671363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner