Healthcare Provider Details

I. General information

NPI: 1528448206
Provider Name (Legal Business Name): KIMBERLY MORRISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 ORANGEBURG RD
SUMMERVILLE SC
29483-8924
US

IV. Provider business mailing address

PO BOX 625
RIDGEVILLE SC
29472-0625
US

V. Phone/Fax

Practice location:
  • Phone: 843-737-3122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: