Healthcare Provider Details

I. General information

NPI: 1225014657
Provider Name (Legal Business Name): CAROLINA RADIOLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SINGLETON RIDGE RD
CONWAY SC
29526-9142
US

IV. Provider business mailing address

PO BOX 678904
DALLAS TX
75267-8904
US

V. Phone/Fax

Practice location:
  • Phone: 843-238-8660
  • Fax:
Mailing address:
  • Phone: 843-467-2676
  • Fax: 843-497-9566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateSC

VIII. Authorized Official

Name: B ED SHELLEY JR.
Title or Position: CEO
Credential: MD
Phone: 843-692-0570