Healthcare Provider Details

I. General information

NPI: 1023797636
Provider Name (Legal Business Name): CAROLINA HEALTH DPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SQUIRES PT STE B
DUNCAN SC
29334-8879
US

IV. Provider business mailing address

700 SQUIRES PT STE B
DUNCAN SC
29334-8879
US

V. Phone/Fax

Practice location:
  • Phone: 864-428-9959
  • Fax: 864-752-1653
Mailing address:
  • Phone: 864-517-0969
  • Fax: 864-752-1653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CLIFFORD BOWERS III
Title or Position: OWNER
Credential: D.O.
Phone: 864-428-9959