Provider Demographics
NPI:1073525879
Name:WHITE, CARL A (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:A
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 N HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 530
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4894
Mailing Address - Country:US
Mailing Address - Phone:803-796-7270
Mailing Address - Fax:803-796-0106
Practice Address - Street 1:146 N HOSPITAL DRIVE
Practice Address - Street 2:SUITE 530
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4894
Practice Address - Country:US
Practice Address - Phone:803-796-7270
Practice Address - Fax:803-796-0106
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5568207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD90792Medicare UPIN