Provider Demographics
NPI:1225005333
Name:GRIMBALL, CAROLYN JONES
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JONES
Last Name:GRIMBALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 GREYSTONE BLVD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-8004
Mailing Address - Country:US
Mailing Address - Phone:803-296-2548
Mailing Address - Fax:803-296-2548
Practice Address - Street 1:PALMETTO HEALTH BAPTIST
Practice Address - Street 2:TAYLOR AT MARION STREETS
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201
Practice Address - Country:US
Practice Address - Phone:803-296-2548
Practice Address - Fax:803-296-2548
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC505367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0516Medicaid
SCQ27393Medicare PIN
SC27393Medicare UPIN