Organization
CAROLINA HEALTH CENTERS, INC.
Active
Other names
Lakelands Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA Y GILMER (PRACTICE ADMINISTRATOR)
(864) 941-8121
Entity
Organization
Contact information
Practice address
17124 HIGHWAY 72 W, WATERLOO, SC 29384-5144
(864) 819-4900
(864) 819-3429
Mailing address
17124 HIGHWAY 72 W, WATERLOO, SC 29384-5144
(864) 819-4900
(864) 819-3429
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FQC058
—
SC
Enumeration date
03/14/2007
Last updated
06/21/2010
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