Organization
CAROLINA FAMILY PSYCHIATRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN J. BRODERICK-CANTWELL M.D. (SOLE PROPRIETOR)
(843) 971-9495
Entity
Organization
Contact information
Practice address
300 W COLEMAN BLVD, SUITE 201, MT PLEASANT, SC 29464-3429
(843) 971-9495
(843) 971-9697
Mailing address
300 W COLEMAN BLVD, SUITE 201, MT PLEASANT, SC 29464-3429
(843) 971-9495
(843) 971-9697
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
28903
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28903
STATE LICENSE
SC
Enumeration date
01/08/2007
Last updated
08/22/2020
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