Organization
CAROLINAS MEDICAL ALLIANCE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(615) 465-7000
Entity
Organization
Contact information
Practice address
101 JOHN ST, LAKE CITY, SC 29560-2411
(843) 394-2031
Mailing address
101 JOHN ST, LAKE CITY, SC 29560-2411
(843) 394-2031
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3161
—
SC
Enumeration date
04/28/2006
Last updated
10/29/2007
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