Individual
MR. CARROLL BROOKS BANNISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 MEDICAL PARK DR, SUITE 101, HARTSVILLE, SC 29550-4777
(843) 339-4295
(843) 339-4609
Mailing address
701 MEDICAL PARK DR, STE 300, HARTSVILLE, SC 29550-4777
(843) 878-1101
(843) 656-1212
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
7718
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
077188
—
SC
Enumeration date
07/18/2006
Last updated
03/09/2012
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