Healthcare Provider Details

I. General information

NPI: 1902898562
Provider Name (Legal Business Name): CARL ALVIN FOULKS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RICHLAND MEDICAL PARK DR STE 120
COLUMBIA SC
29203-6850
US

IV. Provider business mailing address

106 ALEXANDER BANK DR STE 200
MOORESVILLE NC
28117-9624
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-8866
  • Fax: 803-933-3049
Mailing address:
  • Phone: 704-660-2622
  • Fax: 704-662-2633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number93611
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number9900221
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: