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General NPI Number Information
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NPI Number | 1124342506
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Entity Type | Organization
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Legal Business Name | CAROLINA PHYSICAL MEDICINE AND
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Dates
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Enumeration Date | 03/15/2010
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Last Update Date | 06/16/2015
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Provider Practice Location Address
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Address Line | 958 E MAIN ST SUITE A
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City | SPARTANBURG
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State | SC
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Zip | 29302-2148
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Country | US
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Telephone | 864-542-0780
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Fax | 864-542-1689
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Provider Business Mailing Address
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Address Line | 958 E MAIN ST SUITE A
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City | SPARTANBURG
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State | SC
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Zip | 29302-2148
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Country | US
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Telephone | 864-542-0780
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Fax | 864-542-1689
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | STEPHANIE C WADDELL
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Credential | CPC
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Telephone | 864-469-2045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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