Healthcare Provider Details

I. General information

NPI: 1649223389
Provider Name (Legal Business Name): CAROLINA PODIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 E CHEVES ST
FLORENCE SC
29506-2616
US

IV. Provider business mailing address

506 EAST CHEVES ST P. O. BOX 1905
FLORENCE SC
29503-1905
US

V. Phone/Fax

Practice location:
  • Phone: 843-413-3100
  • Fax: 843-413-3197
Mailing address:
  • Phone: 843-413-3100
  • Fax: 843-413-3197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY P MUHA
Title or Position: CEO
Credential: D.P.M
Phone: 843-413-3100