Healthcare Provider Details

I. General information

NPI: 1447383666
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 LAUREL ST STE 250
COLUMBIA SC
29204-2035
US

IV. Provider business mailing address

2601 LAUREL ST STE 250
COLUMBIA SC
29204-2035
US

V. Phone/Fax

Practice location:
  • Phone: 803-799-9044
  • Fax: 803-256-8119
Mailing address:
  • Phone: 803-799-9044
  • Fax: 803-256-8119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberPC074
License Number StateSC

VIII. Authorized Official

Name: DR. CHARLES GUY CASTLES III
Title or Position: PRESIDENT
Credential: M.D.
Phone: 803-799-9044