Organization
CAROLINA PEDIATRIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ALETHA MOSLEY (OP DIRECTOR)
(843) 364-1363
Entity
Organization
Contact information
Practice address
105 SCHOOL ST, 3, RIDGEVILLE, SC 29472-8040
(843) 364-1363
Mailing address
105 SCHOOL HOUSE ST, 3, RIDGEVILLE, SC 29472
(843) 364-1363
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G58526
—
SC
Enumeration date
04/16/2012
Last updated
04/16/2012
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