Healthcare Provider Details

I. General information

NPI: 1215585013
Provider Name (Legal Business Name): ADAM CARRAWAY DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 OLD SPARTANBURG RD # A
GREER SC
29650-2763
US

IV. Provider business mailing address

2104 OLD SPARTANBURG RD # A
GREER SC
29650-2763
US

V. Phone/Fax

Practice location:
  • Phone: 864-268-7812
  • Fax:
Mailing address:
  • Phone: 864-268-7812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADAM CARRAWAY
Title or Position: OWNER
Credential: DMD
Phone: 864-268-7812