Organization
CAROLINA FACIAL PLASTIC SURGERY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARLA CAMILLE GRAHAM MD (PRACTICE OWNER)
(843) 665-0400
Entity
Organization
Contact information
Practice address
1714 GREGG AVE, FLORENCE, SC 29501-4120
(843) 665-0400
(843) 667-8487
Mailing address
1714 GREGG AVE, FLORENCE, SC 29501-4120
(843) 665-0400
(843) 667-8487
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
16126
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP2827
—
SC
Enumeration date
07/21/2006
Last updated
01/21/2020
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