# LAKE CAROLINA PAIN AND SPINE CENTER, LLC

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

## Provider details

- **NPI number:** 1326430208
- **Authorized official:** DR. KAMRAN Z KORANLOO M.D. (PHYSICIAN)
- **Authorized official phone:** (803) 764-1228

## Contact information

- **Practice address:** 1821 CLEMSON RD, COLUMBIA, SC 29229-7832
- **Practice address phone:** (803) 788-5916
- **Practice address fax:** (803) 788-9564
- **Mailing address:** 1821 CLEMSON RD, COLUMBIA, SC 29229-7832
- **Mailing address phone:** (803) 788-5916
- **Mailing address fax:** (803) 788-9564

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | 23150 | SC | Yes |

## Other

- **Enumeration date:** 03/02/2015
- **Last updated:** 01/06/2020