Healthcare Provider Details

I. General information

NPI: 1437219979
Provider Name (Legal Business Name): EASTERN CAROLINA PEDIATRIC ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 INDUSTRIAL WAY
DARLINGTON SC
29532-0000
US

IV. Provider business mailing address

PO BOX 799
DARLINGTON SC
29540-0799
US

V. Phone/Fax

Practice location:
  • Phone: 843-395-0015
  • Fax: 843-395-2573
Mailing address:
  • Phone: 843-395-0015
  • Fax: 843-395-2573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES MORRISON FARISH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 843-395-0015