Healthcare Provider Details

I. General information

NPI: 1467031419
Provider Name (Legal Business Name): CAROLINA PAIN AND WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 OLEANDER DR STE 101
MYRTLE BEACH SC
29577-5720
US

IV. Provider business mailing address

4420 OLEANDER DR STE 101
MYRTLE BEACH SC
29577-5720
US

V. Phone/Fax

Practice location:
  • Phone: 843-428-6879
  • Fax: 888-366-8693
Mailing address:
  • Phone: 843-428-6879
  • Fax: 888-366-8693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ELA S CLARIDA
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 843-222-5395