Healthcare Provider Details

I. General information

NPI: 1922114305
Provider Name (Legal Business Name): RADIOLOGY ASSOC OF CAROLINAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110B HOSPITAL DR
SIMPSONVILLE SC
29681-3226
US

IV. Provider business mailing address

PO BOX 669
SIMPSONVILLE SC
29681-0669
US

V. Phone/Fax

Practice location:
  • Phone: 864-228-0355
  • Fax: 864-228-4827
Mailing address:
  • Phone: 864-228-2303
  • Fax: 864-228-3662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number7489
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number19641
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number7489
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number19641
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number7489
License Number StateSC
# 6
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number7489
License Number StateSC
# 7
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number19641
License Number StateNC
# 8
Primary TaxonomyN
Taxonomy Code207RM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Internal Medicine Physician
License Number7489
License Number StateSC
# 9
Primary TaxonomyN
Taxonomy Code207RM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Internal Medicine Physician
License Number19641
License Number StateNC
# 10
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number7489
License Number StateSC
# 11
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number19641
License Number StateNC
# 12
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number7489
License Number StateSC
# 13
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number19641
License Number StateNC
# 14
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number7489
License Number StateSC
# 15
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number19641
License Number StateNC

VIII. Authorized Official

Name: JENNINGS G PRESSLY
Title or Position: OWNER
Credential: MD
Phone: 864-228-2303