# CAROLINA FACIAL PLASTIC SURGERY PA

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

## Provider details

- **NPI number:** 1679594261
- **Authorized official:** DR. CARLA CAMILLE GRAHAM MD (PRACTICE OWNER)
- **Authorized official phone:** (843) 665-0400

## Contact information

- **Practice address:** 1714 GREGG AVE, FLORENCE, SC 29501-4120
- **Practice address phone:** (843) 665-0400
- **Practice address fax:** (843) 667-8487
- **Mailing address:** 1714 GREGG AVE, FLORENCE, SC 29501-4120
- **Mailing address phone:** (843) 665-0400
- **Mailing address fax:** (843) 667-8487

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YS0123X | Facial Plastic Surgery Physician | 16126 | SC | Yes |

## Other

- **Enumeration date:** 07/21/2006
- **Last updated:** 01/21/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GP2827 | — | SC |