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General NPI Number Information
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NPI Number | 1346209129
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Entity Type | Organization
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Legal Business Name | CAROLINA NEUROLOGICAL CLINIC, L.L.P.
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 12/02/2016
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Provider Practice Location Address
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Address Line | 3531 MARY ADER AVE SUITE A
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City | CHARLESTON
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State | SC
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Zip | 29414-5896
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Country | US
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Telephone | 843-723-0202
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Fax | 843-723-1052
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Provider Business Mailing Address
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Address Line | 3531 MARY ADER AVE SUITE A
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City | CHARLESTON
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State | SC
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Zip | 29414-5896
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Country | US
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Telephone | 843-723-0202
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Fax | 843-723-1052
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. JAMES L BUMGARTNER
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Credential | MD
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Telephone | 843-723-0202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State | SC
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