MEDICARE: CAROLINA FOREST URGENT CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1295284784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA FOREST URGENT CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 2128
Second Line	:
City	:	PAWLEYS ISLAND
State	:	SC
Zip	:	29585-2128
Country	:	US
Telephone Number	:	854-223-4831
Fax Number	:	854-212-7381

Provider Business Practice Location Address
First Line	:	185 FRESH DR
Second Line	:	SUITE A
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4436
Country	:	US
Telephone Number	:	843-945-3030
Fax Number	:	843-492-4479

Authorized Official
Title or Position	:	CFO
Name	:	JULIANA R GREGORY
Credential	:
Telephone Number	:	854-223-4831

Provider Enumeration Date	:	09/26/2016
Last Update Date	:	01/21/2026

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