Healthcare Provider Details

I. General information

NPI: 1023238748
Provider Name (Legal Business Name): CAROLYN BIRCHMORE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 N LAKE DR
LEXINGTON SC
29072-7653
US

IV. Provider business mailing address

PO BOX 402145
ATLANTA GA
30384-2145
US

V. Phone/Fax

Practice location:
  • Phone: 803-358-1191
  • Fax: 803-358-1180
Mailing address:
  • Phone: 803-358-1191
  • Fax: 803-358-1180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF625
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: