Provider Demographics
NPI:1467031419
Name:CAROLINA PAIN AND WELLNESS INC
Entity Type:Organization
Organization Name:CAROLINA PAIN AND WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CLARIDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-222-5395
Mailing Address - Street 1:4420 OLEANDER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5720
Mailing Address - Country:US
Mailing Address - Phone:843-428-6879
Mailing Address - Fax:888-366-8693
Practice Address - Street 1:4420 OLEANDER DR STE 101
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5720
Practice Address - Country:US
Practice Address - Phone:843-428-6879
Practice Address - Fax:888-366-8693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty