Organization
CAROLINA GERIATRIC SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MACDONALD MAYES DUBOSE MD (OWNER)
(803) 775-1001
Entity
Organization
Contact information
Practice address
244 CHURCH ST, SUMTER, SC 29150-4256
(803) 775-1001
(803) 774-1012
Mailing address
244 CHURCH ST, SUMTER, SC 29150-4256
(803) 775-1001
(803) 774-1012
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
22541
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265418164
—
SC
Enumeration date
06/17/2011
Last updated
07/16/2015
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