Healthcare Provider Details

I. General information

NPI: 1417993346
Provider Name (Legal Business Name): JULIE MARIE KINSMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 MEMORIAL DRIVE EXT
GREER SC
29651-1818
US

IV. Provider business mailing address

1 INDEPENDENCE PT SUITE 212
GREENVILLE SC
29615-4545
US

V. Phone/Fax

Practice location:
  • Phone: 864-877-9066
  • Fax: 864-241-9224
Mailing address:
  • Phone: 864-797-6306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24502
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: