MEDICARE: CAROLINA HEALHT & WELLNESS CENTER, LLC

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	133V00000X	Registered Dietitian	220	SC

General Provider Information

NPI Number	:	1922245810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA HEALHT & WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	7201 BROOKFIELD RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-2215
Country	:	US
Telephone Number	:	803-462-9710
Fax Number	:	803-736-4083

Provider Business Practice Location Address
First Line	:	7201 BROOKFIELD RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-2215
Country	:	US
Telephone Number	:	803-462-9710
Fax Number	:	803-736-4083

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. CARL ISAAC MITCHELL
Credential	:	M.D.
Telephone Number	:	803-462-9710

Provider Enumeration Date	:	01/14/2009
Last Update Date	:	01/14/2009

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