# UROLOGY CLINIC AT CAROLINAS

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CAROLINAS MEDICAL ALLIANCE
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1790131522
- **Legal business name:** CAROLINAS MEDICAL ALLIANCE
- **Authorized official:** MR. LARRY D RABON M.D. (PHYSICIAN)
- **Authorized official phone:** (843) 674-1670

## Contact information

- **Practice address:** 1594 FREEDOM BLVD STE 203, FLORENCE, SC 29505-6046
- **Practice address phone:** (843) 674-1670
- **Practice address fax:** (843) 674-4707
- **Mailing address:** 1594 FREEDOM BLVD STE 203, FLORENCE, SC 29505-6046
- **Mailing address phone:** (843) 674-1670
- **Mailing address fax:** (843) 674-4707

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | 5395 | SC | Yes |

## Other

- **Enumeration date:** 05/11/2016
- **Last updated:** 05/11/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 053952 | — | SC |