Healthcare Provider Details

I. General information

NPI: 1619905809
Provider Name (Legal Business Name): KATHRYN ANNE STEPHENSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN A HICKMAN MD

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 RICHLAND MEDICAL PARK DR STE 310
COLUMBIA SC
29203-6883
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-2300
  • Fax: 803-434-8686
Mailing address:
  • Phone: 803-296-7320
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17543
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: