Healthcare Provider Details

I. General information

NPI: 1154484558
Provider Name (Legal Business Name): CAROLINA BONE & JOINT PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 COLONIAL COMMONS CT
LANCASTER SC
29720-2200
US

IV. Provider business mailing address

PO BOX 5002
MONROE NC
28111-5002
US

V. Phone/Fax

Practice location:
  • Phone: 803-289-2663
  • Fax: 803-286-8332
Mailing address:
  • Phone: 803-289-2663
  • Fax: 803-286-8332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN FRANKLYN BABICH
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 704-289-4595