Provider Demographics
NPI:1902139074
Name:CAROLINA NUTRITION CONSULTANTS INC
Entity Type:Organization
Organization Name:CAROLINA NUTRITION CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:RD,CSG,LD
Authorized Official - Phone:803-996-0312
Mailing Address - Street 1:4721 SUNSET BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9151
Mailing Address - Country:US
Mailing Address - Phone:803-996-0312
Mailing Address - Fax:803-957-2496
Practice Address - Street 1:4721 SUNSET BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9151
Practice Address - Country:US
Practice Address - Phone:803-996-0312
Practice Address - Fax:803-957-2496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty