Healthcare Provider Details

I. General information

NPI: 1215031653
Provider Name (Legal Business Name): CAROLINA RHEUMATOLOGY & NEUROLOGY ASSOC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 NIGELS DRIVE
MYRTLE BEACH SC
29572-4125
US

IV. Provider business mailing address

8220 NIGELS DRIVE
MYRTLE BEACH SC
29572-4125
US

V. Phone/Fax

Practice location:
  • Phone: 843-692-0968
  • Fax: 843-692-2688
Mailing address:
  • Phone: 843-692-0968
  • Fax: 843-692-2688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARI WILSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 843-692-0968