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General NPI Number Information
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NPI Number | 1225014657
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Entity Type | Organization
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Legal Business Name | CAROLINA RADIOLOGY ASSOCIATES LLC
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Dates
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Enumeration Date | 12/18/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 300 SINGLETON RIDGE RD
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City | CONWAY
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State | SC
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Zip | 29526-9142
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Country | US
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Telephone | 843-238-8660
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 678904
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City | DALLAS
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State | TX
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Zip | 75267-8904
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Country | US
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Telephone | 843-467-2676
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Fax | 843-497-9566
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Authorized Official
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Title or Position | CEO
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Name | B ED SHELLEY JR.
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Credential | MD
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Telephone | 843-692-0570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | SC
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