Provider Demographics
NPI:1922345529
Name:CAROLINA NEUROLOGY OF SPARTANBURG
Entity Type:Organization
Organization Name:CAROLINA NEUROLOGY OF SPARTANBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOOISTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-585-6179
Mailing Address - Street 1:541 FLOYD RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1520
Mailing Address - Country:US
Mailing Address - Phone:864-585-6179
Mailing Address - Fax:864-585-5403
Practice Address - Street 1:541 FLOYD RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1520
Practice Address - Country:US
Practice Address - Phone:864-585-6179
Practice Address - Fax:864-585-5403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC133492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty