Provider Demographics
NPI:1699803528
Name:FENWICK, CAROL GREEN (RD, LD)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:GREEN
Last Name:FENWICK
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 MATHIS FERRY RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-9728
Mailing Address - Country:US
Mailing Address - Phone:843-670-1997
Mailing Address - Fax:843-388-0117
Practice Address - Street 1:1514 MATHIS FERRY RD
Practice Address - Street 2:SUITE 207
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-9728
Practice Address - Country:US
Practice Address - Phone:843-670-1997
Practice Address - Fax:843-388-0117
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC674OtherDIETETICS PRACTICE LICENSE