Provider Demographics
NPI:1891126272
Name:COLQUITT- BOYD, CAROLINE ELIZABETH (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:ELIZABETH
Last Name:COLQUITT- BOYD
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:MRS
Other - First Name:CAROLINE
Other - Middle Name:ELIXABETH
Other - Last Name:COLQUITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:853 N CHURCH ST
Practice Address - Street 2:SUITE 720C
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3098
Practice Address - Country:US
Practice Address - Phone:864-560-6419
Practice Address - Fax:864-560-7498
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1057133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ514235193OtherMEDICARE PIN
SCQ514236066OtherMEDICARE PIN
SCQ514235019OtherMEDICARE PIN
SCQ514236067OtherMEDICARE PIN
SCDT1061Medicaid
SCQ514233365OtherMEDICARE PIN
SCQ514233365OtherMEDICARE PIN
SCQ514235193Medicare PIN
SCQ514235193OtherMEDICARE PIN
SCQ514236066Medicare PIN