Healthcare Provider Details

I. General information

NPI: 1780270744
Provider Name (Legal Business Name): CAROLINA PEDIATRICS AT ROCK HILL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 HERLONG AVE S STE 201
ROCK HILL SC
29732-2168
US

IV. Provider business mailing address

225 HERLONG AVE S STE 201
ROCK HILL SC
29732-2168
US

V. Phone/Fax

Practice location:
  • Phone: 803-327-9999
  • Fax:
Mailing address:
  • Phone: 803-327-9999
  • Fax: 803-327-9998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CARLOS G PAXTOR
Title or Position: PEDIATRICIAN/PROVIDER
Credential: MD
Phone: 803-327-9999