Provider Demographics
NPI:1265500409
Name:PAULA ORR MD
Entity Type:Organization
Organization Name:PAULA ORR MD
Other - Org Name:CHARLESTON WOMENS WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUS MGR
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-767-2121
Mailing Address - Street 1:5319 PARKSHIRE WAY
Mailing Address - Street 2:STE B
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-2051
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5319 PARKSHIRE WAY
Practice Address - Street 2:STE B
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-2051
Practice Address - Country:US
Practice Address - Phone:843-767-2121
Practice Address - Fax:843-767-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20332332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2837Medicaid
4226103OtherOTHER ID NUMBER
4226103OtherOTHER ID NUMBER-COMMERCIAL NUMBER