MEDICARE: DR. SAMUEL KEITH PARISH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	42966	TN
2	207Q00000X	Family Medicine Physician	ME98798	FL
3	207QA0401X	Addiction Medicine (Family Medicine) Physician	ME98798	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02146	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376527580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL KEITH PARISH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 751649
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1649
Country	:	US
Telephone Number	:	843-789-1620
Fax Number	:	843-724-2440

Provider Business Practice Location Address
First Line	:	5133 RIVERS AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-6338
Country	:	US
Telephone Number	:	843-789-1786
Fax Number	:	843-958-1263

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	08/14/2025

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