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General NPI Number Information
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NPI Number | 1366940959
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Entity Type | Organization
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Legal Business Name | KDS CONSULTANTS, LLC
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Dates
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Enumeration Date | 01/29/2018
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 8351 CHARLOTTE HWY STE 200
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City | INDIAN LAND
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State | SC
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Zip | 29707
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Country | US
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Telephone | 803-285-1082
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Fax | 803-283-4329
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Provider Business Mailing Address
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Address Line | 8351 CHARLOTTE HWY STE 200
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City | INDIAN LAND
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State | SC
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Zip | 29707-6553
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Country | US
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Telephone | 803-285-1082
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Fax | 803-283-4329
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEITH D SHEALY
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Credential | MD
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Telephone | 803-285-1082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 15011
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 10924
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License Number State | SC
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