Healthcare Provider Details

I. General information

NPI: 1568641165
Provider Name (Legal Business Name): CAROMONT MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 NAUTICAL DR STE 100A
CLOVER SC
29710-8113
US

IV. Provider business mailing address

PO BOX 744786
ATLANTA GA
30374-4786
US

V. Phone/Fax

Practice location:
  • Phone: 803-631-2858
  • Fax: 803-631-2862
Mailing address:
  • Phone: 704-834-2450
  • Fax: 803-631-2862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID MICHAEL OCONNOR
Title or Position: CFO
Credential:
Phone: 704-671-5343