Healthcare Provider Details

I. General information

NPI: 1316966278
Provider Name (Legal Business Name): KARA J.P. SHRUM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARA JOY PFENNING M.D.

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E GREENVILLE ST SUITE 2200
ANDERSON SC
29621-1580
US

IV. Provider business mailing address

2000 E GREENVILLE ST SUITE 2200
ANDERSON SC
29621-1580
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-7500
  • Fax: 864-512-7575
Mailing address:
  • Phone: 864-512-7500
  • Fax: 864-512-7575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberLL29194
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: