Healthcare Provider Details

I. General information

NPI: 1376509091
Provider Name (Legal Business Name): KIRT A CATON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1254 YEAMANS HALL RD
HANAHAN SC
29410-2787
US

IV. Provider business mailing address

PO BOX 118008
CHARLESTON SC
29423-8008
US

V. Phone/Fax

Practice location:
  • Phone: 843-554-8312
  • Fax: 843-554-5141
Mailing address:
  • Phone: 843-554-8312
  • Fax: 843-554-5141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22293
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: