Provider Demographics
NPI:1285929794
Name:CAROLINA DIGESTIVE DISEASE PA
Entity type:Organization
Organization Name:CAROLINA DIGESTIVE DISEASE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:803-799-8098
Mailing Address - Street 1:2750 LAUREL ST STE 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2024
Mailing Address - Country:US
Mailing Address - Phone:803-799-8098
Mailing Address - Fax:803-255-0018
Practice Address - Street 1:2750 LAUREL ST STE 201
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2024
Practice Address - Country:US
Practice Address - Phone:803-799-8098
Practice Address - Fax:803-255-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19190207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty