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Organization
CAROLINA CENTER FOR DIABETES EDUCATION
Active
Organization
CAROLINA CENTER FOR DIABETES EDUCATION
Active
Parent organization
SPARTANBURG REGIONAL MEDICAL CTR
Organization subpart
Yes
Provider details
NPI number
Legal business name
SPARTANBURG REGIONAL MEDICAL CTR
Authorized official
JANICE FOWLER (CREDENTIALING)
(864) 560-4475
Entity
Organization
Contact information
Practice address
853 N CHURCH ST STE 720C, SPARTANBURG, SC 29303-3098
(864) 560-4304
Mailing address
PO BOX 2168, SPARTANBURG, SC 29304-2168
(864) 560-6419
(864) 560-7498
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
NULL
133V00000X
Registered Dietitian
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
NULL
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DEP019
—
SC
Enumeration date
07/30/2008
Last updated
07/30/2008
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