Provider Demographics
NPI:1528044948
Name:PRYBY, CAROL N (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:N
Last Name:PRYBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:139 LILA DOYLE DR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-9495
Practice Address - Country:US
Practice Address - Phone:864-482-3483
Practice Address - Fax:864-482-3497
Is Sole Proprietor?:No
Enumeration Date:2005-12-17
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046215207Q00000X, 208M00000X
SC90939207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP01268617OtherRAILROAD MEDICARE
GA000808497ADMedicaid
P00172236OtherRR MEDICARE
SCG46215Medicaid
GA08BBRLNMedicare PIN
SCG46215Medicaid
P00172236OtherRR MEDICARE
GA202I081758Medicare PIN