Healthcare Provider Details

I. General information

NPI: 1558304824
Provider Name (Legal Business Name): CAROLINA DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 DEVONSHIRE DR SUITE 102
COLUMBIA SC
29204-2404
US

IV. Provider business mailing address

1701 DEVONSHIRE DR SUITE 102
COLUMBIA SC
29204-2404
US

V. Phone/Fax

Practice location:
  • Phone: 803-758-6003
  • Fax: 803-758-5993
Mailing address:
  • Phone: 803-758-6003
  • Fax: 803-758-5993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL A ALLEN
Title or Position: OWNER/CHIEF TECH
Credential: RVT, RDCS
Phone: 803-758-6003