Provider Demographics
NPI:1306378773
Name:CARESOUTH CAROLINA, INC.
Entity Type:Organization
Organization Name:CARESOUTH CAROLINA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:TEAL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:843-921-2620
Mailing Address - Street 1:715 S DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:CHERAW
Mailing Address - State:SC
Mailing Address - Zip Code:29520-7113
Mailing Address - Country:US
Mailing Address - Phone:843-921-2620
Mailing Address - Fax:
Practice Address - Street 1:715 S DOCTORS DR
Practice Address - Street 2:SUITE E
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520-7113
Practice Address - Country:US
Practice Address - Phone:843-537-0961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20722251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care