Provider Demographics
NPI:1144219742
Name:CHILDREN'S MEDICAL ASSESSMENT CENTER DBA CAROLINA MEDICAL ASSESSMENT C
Entity Type:Organization
Organization Name:CHILDREN'S MEDICAL ASSESSMENT CENTER DBA CAROLINA MEDICAL ASSESSMENT C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-529-4533
Mailing Address - Street 1:3870 LEEDS AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-7493
Mailing Address - Country:US
Mailing Address - Phone:843-529-4533
Mailing Address - Fax:843-529-4539
Practice Address - Street 1:3870 LEEDS AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-7493
Practice Address - Country:US
Practice Address - Phone:843-529-4533
Practice Address - Fax:843-529-4539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20004193OtherSELECT HEALTH OF SC
SCGP1443Medicaid