Provider Demographics
NPI:1033438908
Name:CAROLINA FAMILY PODIATRY,LLC
Entity Type:Organization
Organization Name:CAROLINA FAMILY PODIATRY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:MUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:803-609-1126
Mailing Address - Street 1:131 WILDEWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4300
Mailing Address - Country:US
Mailing Address - Phone:803-462-7040
Mailing Address - Fax:803-462-7047
Practice Address - Street 1:131 WILDEWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4300
Practice Address - Country:US
Practice Address - Phone:803-462-7040
Practice Address - Fax:803-462-7047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC574213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty