NPIMap

Organization Active NPI

Carolina Dermatology PA

Doing business as Carolina Dermatology of Greenville

  • Dermatology Physician
  • Greenville, SC
National Provider Identifier
1104678085
Registry record updated Nov 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
CAROLINA DERMATOLOGY PA
Doing business as
Carolina Dermatology of Greenville
Practice address
5 Stevens St Ste 300
Greenville, SC 29605-4528
Phone
(864) 233-6338
Fax
(864) 235-1982
NPI assigned
Apr 3, 2024
Last updated
Nov 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2025

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

Authorized official

Name
Charles Darragh, MDNPI 1245676774
Title
Shareholder
Phone
(864) 293-0281

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X Primary
MOHS-Micrographic Surgery Physician 207ND0101X

Addresses

Primary practice location

5 Stevens St Ste 300
Greenville, SC 29605-4528

Mailing address

5 Stevens St Ste 300
Greenville, SC 29605-4528
Phone (864) 233-6338

Other practice location 1

10 Enterprise Blvd Ste 202
Greenville, SC 29615-3554
Phone (864) 233-6338

Other names 1

  • Carolina Dermatology of Greenville Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240528001688 SC Part B Supplier - Clinic/Group Practice 8022450659 Receives reassigned benefits from 9 practitioners
Practice locations: Greenville, SC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D0252325Carolina Dermatology, PA5 Stevens St Ste 300, Greenville, SC 29605ComplianceDec 11, 2027
42D2332011Carolina Dermatology, PA10 Enterprise Blvd, Ste 202, Greenville, SC 29615Provider-performed microscopyOct 12, 2027

National Provider Directory

National Provider Directory

Locations

5 Stevens St
Ste 300
Greenville, SC 29605
Phone (864) 233-6338

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1712102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762732800000",
    "number": "1104678085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 STEVENS ST STE 300",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054528",
            "telephone_number": "864-233-6338",
            "fax_number": "864-235-1982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 STEVENS ST STE 300",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054528",
            "telephone_number": "864-233-6338",
            "fax_number": "864-235-1982"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Enterprise Blvd Ste 202",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296153554",
            "country_code": "US",
            "telephone_number": "864-233-6338",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CAROLINA DERMATOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-03",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A",
        "authorized_official_last_name": "DARRAGH",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "SHAREHOLDER",
        "authorized_official_telephone_number": "864-293-0281",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolina Dermatology of Greenville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.