Basic Information
| Provider Information | |||||||||
| NPI: | 1558554956 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROLINA GERIATRIC, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CAROLINA GERIATRIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3010 FARROW RD STE 220 | ||||||||
| Address2: | P.O. BOX 2624 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292037606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8036004517 | ||||||||
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| Practice Location | |||||||||
| Address1: | 830 LAURENS ST | ||||||||
| Address2: | |||||||||
| City: | AIKEN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 298013416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8036496264 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2007 | ||||||||
| LastUpdateDate: | 08/20/2007 | ||||||||
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| AuthorizedOfficialLastName: | GEORGE | ||||||||
| AuthorizedOfficialFirstName: | CHARMAINE | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8036004517 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | F15964 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.