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General NPI Number Information
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NPI Number | 1811201692
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Entity Type | Individual
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Provider Name | KELLI MARIE MCCARTNEY O.D
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Gender | Female
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Dates
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Enumeration Date | 08/04/2010
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 2010 PAXVILLE HWY
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City | MANNING
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State | SC
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Zip | 29102-6434
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Country | US
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Telephone | 803-408-5740
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Fax |
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Provider Business Mailing Address
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Address Line | 107 HISTORY LN
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City | SUMMERVILLE
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State | SC
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Zip | 29485-7850
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Country | US
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Telephone | 843-419-8600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1850
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License Number State | SC
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