=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508809344
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAVIER ENRIQUE CARLES M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2006
-----------------------------------------------------
Last Update Date | 05/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 557 COLUMBIA AVE STE B
-----------------------------------------------------
City | CHAPIN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29036-8324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-345-3414
-----------------------------------------------------
Fax | 803-345-1672
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6069
-----------------------------------------------------
City | WEST COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29171-6069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 22639
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------