Healthcare Provider Details

I. General information

NPI: 1710840046
Provider Name (Legal Business Name): CAROLINA FACE AND BODY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 CHAPIN RD
CHAPIN SC
29036-8875
US

IV. Provider business mailing address

1174 PUTNAM DR
CHAPIN SC
29036-9785
US

V. Phone/Fax

Practice location:
  • Phone: 803-212-5288
  • Fax:
Mailing address:
  • Phone: 803-212-5288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAYLA HUMENANSKY
Title or Position: CHIEF MEDICAL OFFICER
Credential: DO
Phone: 803-212-5288