Provider Demographics
NPI:1558554956
Name:CAROLINA GERIATRIC, LLC
Entity Type:Organization
Organization Name:CAROLINA GERIATRIC, LLC
Other - Org Name:CAROLINA GERIATRIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARMAINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-600-4517
Mailing Address - Street 1:3010 FARROW RD STE 220
Mailing Address - Street 2:P.O. BOX 2624
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-7606
Mailing Address - Country:US
Mailing Address - Phone:803-600-4517
Mailing Address - Fax:
Practice Address - Street 1:830 LAURENS ST
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3416
Practice Address - Country:US
Practice Address - Phone:803-649-6264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF15964207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty