Healthcare Provider Details

I. General information

NPI: 1427508209
Provider Name (Legal Business Name): CAROLINA ORTHOPAEDIC AND NEUROSURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 DEACON TILLER CT
DUNCAN SC
29334-8880
US

IV. Provider business mailing address

1330 BOILING SPRINGS RD SUITE 1600
SPARTANBURG SC
29303-4201
US

V. Phone/Fax

Practice location:
  • Phone: 864-582-6396
  • Fax: 864-582-1608
Mailing address:
  • Phone: 864-582-6396
  • Fax: 864-582-1608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateSC

VIII. Authorized Official

Name: KAREN D WALCHER
Title or Position: OFFICE MANAGER
Credential: BS
Phone: 864-582-6396