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General NPI Number Information
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NPI Number | 1467734558
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Entity Type | Organization
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Legal Business Name | CAROLINA INTEGRATIVE MEDICINE, PA
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Dates
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Enumeration Date | 09/14/2011
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Last Update Date | 09/14/2011
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Provider Practice Location Address
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Address Line | 1011 TIGER BLVD SUITE 300
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City | CLEMSON
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State | SC
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Zip | 29631-2915
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Country | US
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Telephone | 864-324-3704
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 550
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City | CLEMSON
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State | SC
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Zip | 29633-0550
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AIMEE DUFFY
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Credential | M.D.
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Telephone | 864-324-3704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 24716
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License Number State | SC
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