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General NPI Number Information
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NPI Number | 1245300714
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Entity Type | Organization
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Legal Business Name | EASTERN CAROLINA PEDIATRIC ASSOCIATES
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 105 INDUSTRIAL WAY
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City | DARLINGTON
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State | SC
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Zip | 29532-6044
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Country | US
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Telephone | 843-395-6112
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Fax | 843-395-9062
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Provider Business Mailing Address
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Address Line | PO BOX 1730
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City | DARLINGTON
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State | SC
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Zip | 29540-1730
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Country | US
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Telephone | 843-395-6112
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Fax | 843-395-9062
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES MORRISON FARISH
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Credential | M.D.
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Telephone | 843-667-6710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State | SC
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