Provider Demographics
NPI:1083702542
Name:CAROLINA REGIONAL ASSOCIATES OF PATHOLOGY
Entity Type:Organization
Organization Name:CAROLINA REGIONAL ASSOCIATES OF PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:P
Authorized Official - Last Name:HUEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-479-2402
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512
Mailing Address - Country:US
Mailing Address - Phone:843-479-0641
Mailing Address - Fax:843-479-6609
Practice Address - Street 1:672 HWY 9 WEST
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512
Practice Address - Country:US
Practice Address - Phone:843-479-0641
Practice Address - Fax:843-479-6609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory