Healthcare Provider Details

I. General information

NPI: 1740196096
Provider Name (Legal Business Name): UROLOGY SPECIALISTS OF THE CAROLINAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 FORT MILL PKWY STE 101
FORT MILL SC
29715-9810
US

IV. Provider business mailing address

364 FORT MILL PKWY STE 101
FORT MILL SC
29715-9810
US

V. Phone/Fax

Practice location:
  • Phone: 803-825-0457
  • Fax: 704-337-8387
Mailing address:
  • Phone: 803-825-0457
  • Fax: 704-337-8387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: CARRIE LYNN PRUE
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 704-944-6330