Provider Demographics
NPI:1851575518
Name:GAFFNEY HMA PHYSICIAN MANAGEMENT, INC.
Entity Type:Organization
Organization Name:GAFFNEY HMA PHYSICIAN MANAGEMENT, INC.
Other - Org Name:CAROLINA SPORTS MEDICINE AND ORTHOPEDIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCLEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-598-3131
Mailing Address - Street 1:104 PROFESSIONAL PARK
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-2319
Mailing Address - Country:US
Mailing Address - Phone:864-488-3336
Mailing Address - Fax:864-488-4439
Practice Address - Street 1:104 PROFESSIONAL PARK
Practice Address - Street 2:SUITE A
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-2319
Practice Address - Country:US
Practice Address - Phone:864-488-3336
Practice Address - Fax:864-488-4439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13832207XX0005X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC138327Medicaid
SCD79054Medicare UPIN
SCD790548291Medicare PIN