# CAROLINA PEDIATRICS & ADOLESCENT CARE, PA

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

## Provider details

- **NPI number:** 1306805056
- **Authorized official:** DR. PHILIP F. MUBARAK M. D. (PHYSICIAN)
- **Authorized official phone:** (803) 256-0531

## Contact information

- **Practice address:** 2113 ADAMS GRV, SUITE 101, COLUMBIA, SC 29203-7102
- **Practice address phone:** (803) 256-0531
- **Practice address fax:** (803) 765-9052
- **Mailing address:** 2113 ADAMS GRV, SUITE 101, COLUMBIA, SC 29203-6951
- **Mailing address phone:** (803) 256-0531
- **Mailing address fax:** (803) 765-9052

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | 12782 | SC | Yes |

## Other

- **Enumeration date:** 03/21/2006
- **Last updated:** 10/13/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GP0094 | — | SC |