=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902898562
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARL ALVIN FOULKS JR. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2005
-----------------------------------------------------
Last Update Date | 10/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 RICHLAND MEDICAL PARK DR STE 120
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29203-6850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-434-8866
-----------------------------------------------------
Fax | 803-933-3049
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 ALEXANDER BANK DR STE 200
-----------------------------------------------------
City | MOORESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28117-9624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-660-2622
-----------------------------------------------------
Fax | 704-662-2633
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 93611
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 9900221
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------