Provider Demographics
NPI:1710095468
Name:CAROLINA PREVENTIVE MEDICINE ASSOC INC
Entity Type:Organization
Organization Name:CAROLINA PREVENTIVE MEDICINE ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WINGFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-284-5300
Mailing Address - Street 1:234 SEVEN FARMS DRIVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492
Mailing Address - Country:US
Mailing Address - Phone:843-284-5300
Mailing Address - Fax:843-284-5301
Practice Address - Street 1:234 SEVEN FARMS DRIVE
Practice Address - Street 2:SUITE 125
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29492
Practice Address - Country:US
Practice Address - Phone:843-284-5300
Practice Address - Fax:843-284-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty