Provider Demographics
NPI:1346258746
Name:CAUTHEN, CARLTON GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLTON
Middle Name:GREGORY
Last Name:CAUTHEN
Suffix:
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:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3016 LONGTOWN COMMONS DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7861
Practice Address - Country:US
Practice Address - Phone:803-936-8900
Practice Address - Fax:803-935-8667
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL30705207RP1001X
SC30705207RP1001X, 207RC0200X
NC2006-00014207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1346258746Medicaid
SCAA2720Medicare UPIN