Healthcare Provider Details

I. General information

NPI: 1639409808
Provider Name (Legal Business Name): CAROLINA FAMILY CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2010
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 TWO ISLAND CT
MT PLEASANT SC
29466-7436
US

IV. Provider business mailing address

PO BOX 602108
CHARLOTTE NC
28260-2108
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-1414
  • Fax:
Mailing address:
  • Phone: 843-792-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: KARYN RAE
Title or Position: DIRECTOR
Credential:
Phone: 843-876-1344