Provider Demographics
NPI:1841278512
Name:JORGENSEN, CARLA WALKER (MD)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:WALKER
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:3 BUTTERNUT DR
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4655
Practice Address - Country:US
Practice Address - Phone:864-241-7272
Practice Address - Fax:864-672-7852
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30860207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC308606Medicaid
SCP00988080OtherRAILROAD MEDICARE
SCAA2901OtherMEDICARE PTAN
SCAA29017951Medicare PIN