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NPI Code Detail

MEDICARE: ELIZABETH KELLY HUNTLEY MD

MEDICARE: ELIZABETH KELLY HUNTLEY MD
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
1208000000XPediatrics PhysicianLL41065SC
2208000000XPediatrics Physician41065SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508387861
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH KELLY HUNTLEY MD
Provider Business Mailing Address
First Line : 955 RIBAUT RD
Second Line :
City : BEAUFORT
State : SC
Zip : 29902-5454
Country : US
Telephone Number : 843-522-5775
Fax Number : 843-522-5975
Provider Business Practice Location Address
First Line : 955 RIBAUT RD
Second Line :
City : BEAUFORT
State : SC
Zip : 29902-5454
Country : US
Telephone Number : 843-522-5775
Fax Number : 843-522-5975
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2017
Last Update Date : 06/30/2021

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Directions to “ ELIZABETH KELLY HUNTLEY MD” Practice Location

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