Provider Demographics
NPI:1821060997
Name:DUNES PATHOLOGY, LLC
Entity Type:Organization
Organization Name:DUNES PATHOLOGY, LLC
Other - Org Name:DIAGNOSTIC PATHOLOGY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:T
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-213-1790
Mailing Address - Street 1:PO BOX 70549
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572
Mailing Address - Country:US
Mailing Address - Phone:843-213-1790
Mailing Address - Fax:843-213-1830
Practice Address - Street 1:915 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4116
Practice Address - Country:US
Practice Address - Phone:843-213-1790
Practice Address - Fax:843-213-1830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890127GMedicaid
SCCB4464OtherMEDICARE RAILROAD
SCGP0614Medicaid
NC890127GMedicaid