Provider Demographics
NPI:1841445244
Name:CAROLINAS MEDICAL ALLIANCE INC
Entity type:Organization
Organization Name:CAROLINAS MEDICAL ALLIANCE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-892-9813
Mailing Address - Street 1:1594 FREEDOM BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6046
Mailing Address - Country:US
Mailing Address - Phone:843-679-4221
Mailing Address - Fax:843-679-4268
Practice Address - Street 1:1594 FREEDOM BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6046
Practice Address - Country:US
Practice Address - Phone:843-679-4221
Practice Address - Fax:843-679-4268
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS MEDICAL ALLIANCE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-26
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty