Provider Demographics
NPI:1972723096
Name:CAROLINAS MEDICAL ALLIANCE, INC
Entity Type:Organization
Organization Name:CAROLINAS MEDICAL ALLIANCE, INC
Other - Org Name:GRIFFIN FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ARWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-628-6038
Mailing Address - Street 1:105 N RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:SC
Mailing Address - Zip Code:29069-9727
Mailing Address - Country:US
Mailing Address - Phone:843-326-5777
Mailing Address - Fax:843-326-1038
Practice Address - Street 1:105 N RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:SC
Practice Address - Zip Code:29069-9727
Practice Address - Country:US
Practice Address - Phone:843-326-5777
Practice Address - Fax:843-326-1038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC108Medicaid
SC428941Medicare Oscar/Certification