Healthcare Provider Details

I. General information

NPI: 1841134483
Provider Name (Legal Business Name): CARSON MOORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 VILLAGE CREEK DR
BOILING SPRINGS SC
29316-5387
US

IV. Provider business mailing address

316 VILLAGE CREEK DR
BOILING SPRINGS SC
29316-5387
US

V. Phone/Fax

Practice location:
  • Phone: 843-324-7575
  • Fax:
Mailing address:
  • Phone: 843-324-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DAVID CARSON MOORE
Title or Position: OWNER
Credential: PA-C
Phone: 843-324-7575