Provider Demographics
NPI:1427305531
Name:CAROLINA NEUROPATHY CENTER, LLC
Entity type:Organization
Organization Name:CAROLINA NEUROPATHY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:COGDILL
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:864-981-2846
Mailing Address - Street 1:101 PROFESSIONAL PARK
Mailing Address - Street 2:SUITE D
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-2319
Mailing Address - Country:US
Mailing Address - Phone:864-489-1446
Mailing Address - Fax:864-489-4909
Practice Address - Street 1:101 PROFESSIONAL PARK
Practice Address - Street 2:SUITE D
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-2319
Practice Address - Country:US
Practice Address - Phone:864-489-1446
Practice Address - Fax:864-489-4909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC086296163W00000X
SCMD9903208D00000X
SCF4423363LF0000X
NC201538363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty