Healthcare Provider Details

I. General information

NPI: 1942277421
Provider Name (Legal Business Name): CARLA W ROBERTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLA M WEST MD

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MEDICAL PARK RD SUITE 203
COLUMBIA SC
29203-6873
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-3533
  • Fax: 803-434-3094
Mailing address:
  • Phone: 803-296-7320
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number22759
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: