Healthcare Provider Details

I. General information

NPI: 1225028806
Provider Name (Legal Business Name): KIMBERLY M DEVOLLD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY S ROHALEY MD

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2754 MAYBANK HWY STE B
JOHNS ISLAND SC
29455-4809
US

IV. Provider business mailing address

2754 MAYBANK HWY STE B
JOHNS ISLAND SC
29455-4809
US

V. Phone/Fax

Practice location:
  • Phone: 843-996-4908
  • Fax: 843-962-5450
Mailing address:
  • Phone: 843-996-4908
  • Fax: 843-962-5450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME86723
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35094744
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101241911
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number43204
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD40634
License Number StateSC
# 6
Primary TaxonomyN
Taxonomy Code2080B0002X
TaxonomyPediatric Obesity Medicine Physician
License Number0101241911
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code2080B0002X
TaxonomyPediatric Obesity Medicine Physician
License NumberMD40634
License Number StateSC
# 8
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101241911
License Number StateVA
# 9
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD40634
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: