Provider Demographics
NPI:1659722411
Name:ROBERTS, CARMEN CRIBB (DO)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:CRIBB
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-3160
Mailing Address - Country:US
Mailing Address - Phone:803-433-0439
Mailing Address - Fax:803-433-9840
Practice Address - Street 1:200 E HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-3160
Practice Address - Country:US
Practice Address - Phone:803-433-0439
Practice Address - Fax:803-433-9840
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL39358207Q00000X
SC39358207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC393586Medicaid