Provider Demographics
NPI:1679269823
Name:GREEN, CAROLINE CALDER (PA)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:CALDER
Last Name:GREEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N SUMTER ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4967
Mailing Address - Country:US
Mailing Address - Phone:803-774-1550
Mailing Address - Fax:
Practice Address - Street 1:115 N SUMTER ST STE 300
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4967
Practice Address - Country:US
Practice Address - Phone:803-774-1550
Practice Address - Fax:803-775-7258
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4895363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant