Healthcare Provider Details

I. General information

NPI: 1265482913
Provider Name (Legal Business Name): KRISTA MARIE PRIGG KOZACKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTA MARIE KOZACKI M.D.

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3380 PINE NEEDLES RD
FLORENCE SC
29501-7908
US

IV. Provider business mailing address

360 N IRBY ST
FLORENCE SC
29501-2808
US

V. Phone/Fax

Practice location:
  • Phone: 843-432-2952
  • Fax: 843-799-1959
Mailing address:
  • Phone: 843-667-9414
  • Fax: 843-667-1362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16436
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: