Organization
CAROLINA INDEPENDENT ID, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES GREGORY THOMAS MD (OWNER)
(843) 270-9518
Entity
Organization
Contact information
Practice address
1200 HOSPITAL DR, MT PLEASANT, SC 29464-3251
(843) 270-9518
Mailing address
1050 JOHNNIE DODDS BLVD, #793, MT PLEASANT, SC 29465-2801
(843) 270-9518
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
20983
SC
Other
Enumeration date
07/16/2013
Last updated
07/16/2013
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