CAROLINA WELLNESS CLINIC LLC NPI 1992259139

NPI Information

NPI: 1992259139
Provider Name: CAROLINA WELLNESS CLINIC, LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 42D1094073

Address:
958 E MAIN ST
SUITE B
SPARTANBURG, SC
ZIP 29302
Phone: (864) 641-6632
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CAROLINA WELLNESS CLINIC, LLC is a family nurse practitioner in Spartanburg, SC. CAROLINA WELLNESS CLINIC, LLC NPI is 1992259139. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

958 E MAIN ST
SUITE B
SPARTANBURG, SC
ZIP 29302-148
Phone: (864) 641-6632

The provider's authorized official is Damien Bailey .
The authorized official title is Owner and has the following contact phone number (864) 641-6632.

The CLIA number assigned to this NPI record is 42D1094073 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/4/2016 and was last updated on 8/4/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	4470	SOUTH CAROLINA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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