Provider Demographics
NPI:1487659660
Name:CARNOHAN, PETER SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:SCOTT
Last Name:CARNOHAN
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 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:14 MEDICAL PARK DRIVE
Practice Address - Street 2:SUITE 320
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6896
Practice Address - Country:US
Practice Address - Phone:803-434-6771
Practice Address - Fax:803-434-3955
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22695207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01721425OtherMEDICARE RR PIN
SC179434Medicaid
SCH942407924Medicare ID - Type UnspecifiedMEDICARE #
SC179434Medicaid
SCSC26845773Medicare PIN