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General NPI Number Information
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NPI Number | 1376961631
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Entity Type | Organization
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Legal Business Name | CAROLINA SPINE AND PAIN MANAGEMENT LLC
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Dates
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Enumeration Date | 04/03/2014
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Last Update Date | 04/03/2014
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Provider Practice Location Address
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Address Line | 420 THE PKWY STE N
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City | GREER
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State | SC
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Zip | 29650-5205
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Country | US
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Telephone | 864-968-2310
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Fax |
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Provider Business Mailing Address
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Address Line | 420 THE PKWY STE N
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City | GREER
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State | SC
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Zip | 29650-5205
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Country | US
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Telephone | 864-968-2310
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH GRANT
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Credential | MD
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Telephone | 864-968-2310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 33418
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License Number State | SC
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