Healthcare Provider Details

I. General information

NPI: 1265500409
Provider Name (Legal Business Name): PAULA ORR MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5319 PARKSHIRE WAY STE B
N CHARLESTON SC
29418-2051
US

IV. Provider business mailing address

5319 PARKSHIRE WAY STE B
N CHARLESTON SC
29418-2051
US

V. Phone/Fax

Practice location:
  • Phone: 843-767-2121
  • Fax: 843-767-2112
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number20332
License Number StateSC

VIII. Authorized Official

Name: JOHNNY ORR
Title or Position: BUS MGR
Credential:
Phone: 843-767-2121