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General NPI Number Information
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NPI Number | 1124313101
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Entity Type | Organization
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Legal Business Name | CAROLINA GERIATRIC SPECIALISTS, LLC
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Dates
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Enumeration Date | 06/17/2011
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 244 CHURCH ST
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City | SUMTER
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State | SC
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Zip | 29150-4256
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Country | US
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Telephone | 803-775-1001
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Fax | 803-774-1012
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Provider Business Mailing Address
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Address Line | 244 CHURCH ST
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City | SUMTER
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State | SC
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Zip | 29150-4256
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Country | US
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Telephone | 803-775-1001
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Fax | 803-774-1012
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Authorized Official
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Title or Position | OWNER
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Name | DR. MACDONALD MAYES DUBOSE
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Credential | MD
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Telephone | 803-775-1001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 22541
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License Number State | SC
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