Healthcare Provider Details

I. General information

NPI: 1275568149
Provider Name (Legal Business Name): CAROLINA INTERVENTIONAL PAIN ASSOCIATES, P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 PATRICIA LANE SUITE 102
FORT MILL SC
29708
US

IV. Provider business mailing address

1750 HIGHWAY 160 WEST, SUITE 1010-319
FORT MILL SC
29708
US

V. Phone/Fax

Practice location:
  • Phone: 803-802-7100
  • Fax: 803-791-9200
Mailing address:
  • Phone: 803-802-7100
  • Fax: 803-791-9200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GISELE JACQUELINE GIRAULT
Title or Position: PRESIDENT
Credential: MD
Phone: 803-802-7100