MEDICARE: LAURENS COUNTY HEALTHCARE SYSTEM DBA CAROLINA WOMENS CENTER

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	207V00000X	Obstetrics & Gynecology Physician	15652	SC

General Provider Information

NPI Number	:	1841580230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURENS COUNTY HEALTHCARE SYSTEM DBA CAROLINA WOMENS CENTER

Provider Business Mailing Address
First Line	:	102 MEDICAL PARK CT
Second Line	:
City	:	CLINTON
State	:	SC
Zip	:	29325-7537
Country	:	US
Telephone Number	:	864-938-0087
Fax Number	:	864-938-0229

Provider Business Practice Location Address
First Line	:	102 MEDICAL PARK CT
Second Line	:
City	:	CLINTON
State	:	SC
Zip	:	29325-7537
Country	:	US
Telephone Number	:	864-938-0087
Fax Number	:	864-938-0229

Authorized Official
Title or Position	:	VP AND CFO OF LCHCS
Name	:	MR. WILLIS J GRANT IV
Credential	:
Telephone Number	:	864-833-3976

Provider Enumeration Date	:	04/19/2011
Last Update Date	:	04/19/2011

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