Healthcare Provider Details

I. General information

NPI: 1679557516
Provider Name (Legal Business Name): CAROLINA NEPHROLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 MILLS AVENUE
GREENVILLE SC
29605-4019
US

IV. Provider business mailing address

203 MILLS AVENUE
GREENVILLE SC
29605-4019
US

V. Phone/Fax

Practice location:
  • Phone: 864-271-1844
  • Fax: 864-271-3714
Mailing address:
  • Phone: 864-271-1844
  • Fax: 864-271-3714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN KOHARA
Title or Position: CONTROLLER
Credential:
Phone: 864-271-1844