Organization
CAROLINA FOREST IMAGING CENTER LLC
Active
Organization
CAROLINA FOREST IMAGING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAVELLE R HARDIN (CREDENTIALING COORDINATOR)
(615) 344-8203
Entity
Organization
Contact information
Practice address
199 VILLAGE CENTER BLVD, SUITE 110, MYRTLE BEACH, SC 29579
(843) 236-7878
(843) 236-6406
Mailing address
199 VILLAGE CENTER BLVD, SUITE 110, MYRTLE BEACH, SC 29579
(843) 236-7878
(843) 236-6406
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4758
—
SC
Enumeration date
08/09/2007
Last updated
11/30/2007
Update your record
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