Provider Demographics
NPI:1316940059
Name:SOFLEY, CARL WILSON (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:WILSON
Last Name:SOFLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-512-6024
Mailing Address - Fax:864-512-6123
Practice Address - Street 1:2000 E GREENVILLE ST
Practice Address - Street 2:STE 3850
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1580
Practice Address - Country:US
Practice Address - Phone:864-512-6024
Practice Address - Fax:864-512-6123
Is Sole Proprietor?:No
Enumeration Date:2005-05-26
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13625207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00544651AMedicaid
SC136258Medicaid
SCF45127Medicare UPIN
3619Medicare PIN