Provider Demographics
NPI:1346209129
Name:CAROLINA NEUROLOGICAL CLINIC, L.L.P.
Entity Type:Organization
Organization Name:CAROLINA NEUROLOGICAL CLINIC, L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUMGARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-723-0202
Mailing Address - Street 1:3531 MARY ADER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5896
Mailing Address - Country:US
Mailing Address - Phone:843-723-0202
Mailing Address - Fax:843-723-1052
Practice Address - Street 1:3531 MARY ADER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5896
Practice Address - Country:US
Practice Address - Phone:843-723-0202
Practice Address - Fax:843-723-1052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3124Medicare PIN