Healthcare Provider Details

I. General information

NPI: 1518238690
Provider Name (Legal Business Name): CAROLINA HEALTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2012
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23265 HIGHWAY 76 E
CLINTON SC
29325-7532
US

IV. Provider business mailing address

313 MAIN ST STE B
GREENWOOD SC
29646-2757
US

V. Phone/Fax

Practice location:
  • Phone: 864-547-8300
  • Fax: 864-833-3530
Mailing address:
  • Phone: 864-388-0301
  • Fax: 864-388-1718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA Y GILMER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 864-941-8121