Healthcare Provider Details

I. General information

NPI: 1073686994
Provider Name (Legal Business Name): KERSHAWHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 ROBERTS ST
CAMDEN SC
29020-3737
US

IV. Provider business mailing address

PO BOX 7003
CAMDEN SC
29020-7003
US

V. Phone/Fax

Practice location:
  • Phone: 803-713-6376
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number StateSC

VIII. Authorized Official

Name: DONNIE J WEEKS
Title or Position: CEO
Credential:
Phone: 803-713-6227