Provider Demographics
NPI:1598808628
Name:CAROLINA PODIATRIC MEDICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:CAROLINA PODIATRIC MEDICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:C. RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HIOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-649-3668
Mailing Address - Street 1:721 RICHLAND AVE W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-3831
Mailing Address - Country:US
Mailing Address - Phone:803-649-3668
Mailing Address - Fax:803-649-3848
Practice Address - Street 1:721 RICHLAND AVE W
Practice Address - Street 2:SUITE 100
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3831
Practice Address - Country:US
Practice Address - Phone:803-649-3668
Practice Address - Fax:803-649-3848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty