Healthcare Provider Details

I. General information

NPI: 1902139074
Provider Name (Legal Business Name): CAROLINA NUTRITION CONSULTANTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4721 SUNSET BLVD SUITE D
LEXINGTON SC
29072-9151
US

IV. Provider business mailing address

4721 SUNSET BLVD SUITE D
LEXINGTON SC
29072-9151
US

V. Phone/Fax

Practice location:
  • Phone: 803-996-0312
  • Fax: 803-957-2496
Mailing address:
  • Phone: 803-996-0312
  • Fax: 803-957-2496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: EDNA M COX
Title or Position: OWNER
Credential: RD,CSG,LD
Phone: 803-996-0312