Basic Information
| Provider Information | |||||||||
| NPI: | 1306378773 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARESOUTH CAROLINA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 715 S DOCTORS DR | ||||||||
| Address2: | |||||||||
| City: | CHERAW | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295207113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8439212620 | ||||||||
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| Practice Location | |||||||||
| Address1: | 715 S DOCTORS DR | ||||||||
| Address2: | SUITE E | ||||||||
| City: | CHERAW | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295207113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435370961 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2017 | ||||||||
| LastUpdateDate: | 04/03/2017 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TEAL | ||||||||
| AuthorizedOfficialFirstName: | TRACY | ||||||||
| AuthorizedOfficialMiddleName: | JOHNSON | ||||||||
| AuthorizedOfficialTitleorPosition: | FAMILY NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 8439212620 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | FNP-C | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251J00000X | 20722 | SC | Y | Agencies | Nursing Care |
No ID Information.