Healthcare Provider Details

I. General information

NPI: 1336272400
Provider Name (Legal Business Name): CAROLINA HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219B NORTH MINE STREET
MCCORMICK SC
29835
US

IV. Provider business mailing address

313 MAIN ST
GREENWOOD SC
29646-2757
US

V. Phone/Fax

Practice location:
  • Phone: 864-852-2571
  • Fax: 864-852-2674
Mailing address:
  • Phone: 864-852-2571
  • Fax: 864-852-2674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA Y GILMER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 864-396-0117