Healthcare Provider Details

I. General information

NPI: 1437179983
Provider Name (Legal Business Name): CAROLINA CONTINENCE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 HALTON ROAD
GREENVILLE SC
29607
US

IV. Provider business mailing address

369 HALTON ROAD
GREENVILLE SC
29607
US

V. Phone/Fax

Practice location:
  • Phone: 864-286-1520
  • Fax: 864-286-1462
Mailing address:
  • Phone: 864-286-1520
  • Fax: 864-286-1462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number18432
License Number StateSC

VIII. Authorized Official

Name: THOMAS FLEMING MATTOX
Title or Position: OWNER
Credential: MD
Phone: 864-286-1520