Individual provider Active NPI

Carla Wyatt-Ingram

  • Obstetrics & Gynecology Physician
  • Greenville, SC
National Provider Identifier
1093519068
Registry record updated Jul 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
LL94993 Issued in SC
Practice address
1120 Grove Rd
Greenville, SC 29605-4656
Phone
(864) 455-8897
NPI assigned
Apr 1, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X LL94993 SC Primary

Addresses

Primary practice location

1120 Grove Rd
Greenville, SC 29605-4656

Mailing address

1120 Grove Rd
Greenville, SC 29605-4656

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250825001944 SC Order and Referring Only - Obstetrics/GynecologyPractitioner - Obstetrics/Gynecology 5991205858

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LL94993SCMDObstetrics & Gynecology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1743465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753142400000",
    "number": "1093519068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 GROVE RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 GROVE RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054656",
            "telephone_number": "864-455-8897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT-INGRAM",
        "first_name": "CARLA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-04-01",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "SC",
            "license": "LL94993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.