Organization
CAROLINA DERMATOLOGY GRP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA K GRANT (PRACTICE MANAGER)
(803) 771-7506
Entity
Organization
Contact information
Practice address
1777 SAINT JULIAN PL, COLUMBIA, SC 29204-2419
(803) 771-7506
(803) 771-9455
Mailing address
220 GRACES WAY, COLUMBIA, SC 29229-1613
(803) 771-7506
(803) 771-9455
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
SC
207ND0101X
MOHS-Micrographic Surgery Physician
—
SC
207ND0900X
Dermatopathology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP1028
—
SC
Enumeration date
01/11/2006
Last updated
03/26/2026
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