# CAROLINA RADIATION MEDICINE, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053315093
- **Authorized official:** GORDON GARY KOLTIS MD (PRESIDENT)
- **Authorized official phone:** (252) 329-0025

## Contact information

- **Practice address:** 801 W H SMITH BLVD, GREENVILLE, NC 27834-3764
- **Practice address phone:** (252) 329-0025
- **Practice address fax:** (252) 329-0325
- **Mailing address:** 801 W H SMITH BLVD, GREENVILLE, NC 27834-3764
- **Mailing address phone:** (252) 329-0025
- **Mailing address fax:** (252) 329-0325

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0200X | Radiology Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/08/2005
- **Last updated:** 07/18/2008