Healthcare Provider Details

I. General information

NPI: 1871122929
Provider Name (Legal Business Name): SIMBIAT KEHINDE OLAYIWOLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E CHEVES ST
FLORENCE SC
29506-2632
US

IV. Provider business mailing address

801 E CHEVES ST
FLORENCE SC
29506-2632
US

V. Phone/Fax

Practice location:
  • Phone: 843-777-7035
  • Fax: 843-777-5889
Mailing address:
  • Phone: 843-777-7035
  • Fax: 843-777-5889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number89869
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: