Healthcare Provider Details

I. General information

NPI: 1740575307
Provider Name (Legal Business Name): ROBERT MATTHEW CARLILE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2011
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 FRONT ST SUITE 230
SUMMERVILLE SC
29486-7722
US

IV. Provider business mailing address

PO BOX 530062
ATLANTA GA
30353-0062
US

V. Phone/Fax

Practice location:
  • Phone: 843-569-1856
  • Fax: 843-569-1879
Mailing address:
  • Phone: 843-695-6071
  • Fax: 843-569-5879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number39441
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: