Healthcare Provider Details

I. General information

NPI: 1124996186
Provider Name (Legal Business Name): CAROLYN DENISE OGRODNIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NNPTC CIR
GOOSE CREEK SC
29445-6314
US

IV. Provider business mailing address

110 NNPTC CIR
GOOSE CREEK SC
29445-6314
US

V. Phone/Fax

Practice location:
  • Phone: 843-794-6835
  • Fax: 843-794-6034
Mailing address:
  • Phone: 843-794-6835
  • Fax: 843-794-6034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number86777
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: