Provider Demographics
NPI:1306191077
Name:CAROLINA PRIMARY CARE AND DIABETES CENTER LLC
Entity Type:Organization
Organization Name:CAROLINA PRIMARY CARE AND DIABETES CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-216-1008
Mailing Address - Street 1:3320 N HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-3626
Mailing Address - Country:US
Mailing Address - Phone:610-216-1008
Mailing Address - Fax:
Practice Address - Street 1:3320 N HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3626
Practice Address - Country:US
Practice Address - Phone:864-231-0235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34406207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty