Individual
CARROLL H FOWLKES III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
BEAUFORT MEMORIAL EXPRESS CARE & OCCUPATIONAL HEALTH, 1 BURNT CHURCH RD, STE A, BLUFFTON, SC 29910-6405
(843) 706-2185
(855) 299-5693
Mailing address
955 RIBAUT RD, BMAC CREDENTIALING, BEAUFORT, SC 29902-5441
(843) 522-7843
(843) 522-5678
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0102049892
VA
207P00000X
Emergency Medicine Physician
Primary
36208
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0045396000
—
WV
05
—
362084
—
SC
05
—
6017444
—
VA
Enumeration date
03/23/2006
Last updated
01/08/2020
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