Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 4015 | SC |
NPI | 1073593448 |
---|---|
Provider Name | Mrs. Rhonda Gail Carter |
First Address | Rock Hill, SC 29732-1160 |
Second Address | Rock Hill, SC 29732-1160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 16/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V00807 | (02) | SC |
ZX4015 | (05) | SC |