MEDICARE: CAROLINA FAMILY PRACTICE P A

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	207Q00000X	Family Medicine Physician	10933	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	:	1760479620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA FAMILY PRACTICE P A

Provider Business Mailing Address
First Line	:	208 SWIFT CREEK RD
Second Line	:
City	:	HARTSVILLE
State	:	SC
Zip	:	29550-4383
Country	:	US
Telephone Number	:	843-383-0770
Fax Number	:	843-383-5856

Provider Business Practice Location Address
First Line	:	208 SWIFT CREEK RD
Second Line	:
City	:	HARTSVILLE
State	:	SC
Zip	:	29550-4383
Country	:	US
Telephone Number	:	843-383-0770
Fax Number	:	843-383-5856

Authorized Official
Title or Position	:	MD/OWNER
Name	:	DR. KENNETH C EVANS
Credential	:
Telephone Number	:	843-383-0770

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	03/06/2015

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Directions to “CAROLINA FAMILY PRACTICE P A ” Practice Location

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