Healthcare Provider Details

I. General information

NPI: 1437188661
Provider Name (Legal Business Name): CAROLINA ENT, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 COMMONWEALTH DR SUITE 230
GREENVILLE SC
29615-4883
US

IV. Provider business mailing address

131 COMMONWEALTH DR SUITE 230
GREENVILLE SC
29615-4883
US

V. Phone/Fax

Practice location:
  • Phone: 864-281-9440
  • Fax:
Mailing address:
  • Phone: 864-281-9440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JOAN MOORE
Title or Position: OFFICE MANAGER
Credential:
Phone: 864-281-9440