Healthcare Provider Details

I. General information

NPI: 1831281195
Provider Name (Legal Business Name): CAROLINA FOREST FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4022 POSTAL WAY
MYRTLE BEACH SC
29579
US

IV. Provider business mailing address

4022 POSTAL WAY
MYRTLE BEACH SC
29579
US

V. Phone/Fax

Practice location:
  • Phone: 843-236-9925
  • Fax: 843-238-1624
Mailing address:
  • Phone: 843-236-9925
  • Fax: 843-238-1624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13280
License Number StateSC

VIII. Authorized Official

Name: JAMES M VEST
Title or Position: OWNER
Credential: MD
Phone: 843-238-5654