Provider Demographics
NPI:1275515108
Name:PINNER, CARROLL ALEXANDER III (MD)
Entity Type:Individual
Prefix:
First Name:CARROLL
Middle Name:ALEXANDER
Last Name:PINNER
Suffix:III
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:P O BOX 99
Mailing Address - Street 2:
Mailing Address - City:PEAK
Mailing Address - State:SC
Mailing Address - Zip Code:29122-0099
Mailing Address - Country:US
Mailing Address - Phone:803-945-7475
Mailing Address - Fax:803-345-2832
Practice Address - Street 1:32 RIVER ST
Practice Address - Street 2:
Practice Address - City:PEAK
Practice Address - State:SC
Practice Address - Zip Code:29122
Practice Address - Country:US
Practice Address - Phone:803-945-7475
Practice Address - Fax:803-345-2832
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6376207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC063763Medicaid
B92148Medicare UPIN
SC063763Medicaid