MEDICARE: CAROLINA FAMILY CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	75-17508	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750318101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA FAMILY CARE, INC

Provider Business Mailing Address
First Line	:	PO BOX 602108
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-2108
Country	:	US
Telephone Number	:	843-792-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	2125 CHARLIE HALL BLVD
Second Line	:	SUITE 2A
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5879
Country	:	US
Telephone Number	:	843-571-6555
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	KARYN RAE
Credential	:
Telephone Number	:	843-876-1344

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	01/09/2019

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