Provider Demographics
NPI:1104006154
Name:CAROLINA DIABETES AND ENDOCRINOLOGY
Entity type:Organization
Organization Name:CAROLINA DIABETES AND ENDOCRINOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:YEBOAH
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:864-261-6440
Mailing Address - Street 1:1221 N FANT ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-4821
Mailing Address - Country:US
Mailing Address - Phone:864-261-6440
Mailing Address - Fax:
Practice Address - Street 1:1221 N FANT ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4821
Practice Address - Country:US
Practice Address - Phone:864-261-6440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19586207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty