Healthcare Provider Details

I. General information

NPI: 1134527229
Provider Name (Legal Business Name): CAROLINAS MEDICAL ALLIANCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1594 FREEDOM BLVD STE 205
FLORENCE SC
29505-6046
US

IV. Provider business mailing address

1594 FREEDOM BLVD STE 205
FLORENCE SC
29505-6046
US

V. Phone/Fax

Practice location:
  • Phone: 843-674-1453
  • Fax: 843-674-6810
Mailing address:
  • Phone: 843-674-1453
  • Fax: 843-674-6810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES P WRIGHT
Title or Position: DIRECTOR
Credential:
Phone: 615-465-7633