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General NPI Number Information
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NPI Number | 1902162803
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Entity Type | Organization
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Legal Business Name | CAROLINA MUSCULOSKELETAL INSTITUTE PA
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Dates
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Enumeration Date | 04/04/2012
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Last Update Date | 04/04/2012
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Provider Practice Location Address
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Address Line | 721 RICHLAND AVE W STE 100
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City | AIKEN
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State | SC
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Zip | 29801-2438
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Country | US
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Telephone | 803-644-4264
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Fax |
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Provider Business Mailing Address
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Address Line | 2980 N BEVERLY GLEN CIR SUITE 301
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City | LOS ANGELES
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State | CA
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Zip | 90077-1726
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Country | US
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Telephone | 310-474-9809
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MACKIE J. WALKER JR.
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Credential | DPM
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Telephone | 803-644-4264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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