Healthcare Provider Details

I. General information

NPI: 1265502744
Provider Name (Legal Business Name): CAROLINA WOMENS CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104B MORGAN PLACE
SUMMERVILLE SC
29485
US

IV. Provider business mailing address

PO BOX 50367
SUMMERVILLE SC
29485
US

V. Phone/Fax

Practice location:
  • Phone: 843-851-3800
  • Fax: 843-851-7787
Mailing address:
  • Phone: 843-851-3800
  • Fax: 843-851-7787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number10650BG
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number10650BG
License Number StateSC

VIII. Authorized Official

Name: MRS. TINA M MITCHUM
Title or Position: OFFICE MANAGER
Credential:
Phone: 843-851-3800