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General NPI Number Information
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NPI Number | 1831228097
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Entity Type | Organization
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Legal Business Name | CAROLINA DIAGNOSTIC SERVICES
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 09/16/2008
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Provider Practice Location Address
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Address Line | 3320 HIGHWAY 153 STE B
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City | PIEDMONT
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State | SC
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Zip | 29673-6713
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Country | US
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Telephone | 864-269-3867
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 792
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City | EASLEY
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State | SC
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Zip | 29641-0792
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Country | US
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Telephone | 864-269-3867
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CLEVE JOHNSON
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Credential |
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Telephone | 864-269-3867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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