Organization
CAROLINA RADIOLOGY ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
B ED SHELLEY JR. MD (CEO)
(843) 692-0570
Entity
Organization
Contact information
Practice address
300 SINGLETON RIDGE RD, CONWAY, SC 29526-9142
(843) 238-8660
Mailing address
PO BOX 678904, DALLAS, TX 75267-8904
(843) 467-2676
(843) 497-9566
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
SC
2085R0204X
Vascular & Interventional Radiology Physician
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5900383
—
NC
01
—
601119
FIRST CHOICE
SC
05
—
890157J
—
NC
05
—
89016MF
—
NC
05
—
89016MG
—
NC
05
—
89016MH
—
NC
05
—
89016MJ
—
NC
05
—
89016MM
—
NC
05
—
89016NC
—
NC
05
—
890177B
—
NC
01
—
CC5487
RAILROAD MEDICARE
SC
05
—
GP1429
—
SC
05
—
GP1849
—
SC
05
—
GP4104
—
SC
Enumeration date
12/18/2005
Last updated
07/21/2022
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