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General NPI Number Information
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NPI Number | 1891976619
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Entity Type | Organization
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Legal Business Name | CAROLINA FAMILY PRACTICE
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Dates
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Enumeration Date | 11/20/2007
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Last Update Date | 09/20/2011
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Provider Practice Location Address
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Address Line | 107 SUNSET DR
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City | MANNING
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State | SC
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Zip | 29102-2904
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Country | US
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Telephone | 803-435-4447
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Fax | 803-435-9092
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Provider Business Mailing Address
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Address Line | 107 SUNSET DR
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City | MANNING
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State | SC
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Zip | 29102-2904
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Country | US
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Telephone | 803-435-4447
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Fax | 803-435-9092
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Authorized Official
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Title or Position | OWNER
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Name | DR. GEORGE R JONES JR.
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Credential |
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Telephone | 803-435-4447
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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 | 088489
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License Number State | SC
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