Healthcare Provider Details

I. General information

NPI: 1508838095
Provider Name (Legal Business Name): CAROLINA OB-GYN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4017 HWY 17 BYPASS
MURRELLS INLET SC
29576-2674
US

IV. Provider business mailing address

4017 HWY 17 BYPASS PO BOX 3440
MURRELLS INLET SC
29576-2674
US

V. Phone/Fax

Practice location:
  • Phone: 843-651-6525
  • Fax: 843-357-5035
Mailing address:
  • Phone: 843-651-6525
  • Fax: 843-357-5035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: GAYLE S RICHMOND
Title or Position: MANAGER/PARTNER
Credential: MD
Phone: 843-651-6525