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General NPI Number Information
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NPI Number | 1902802796
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Entity Type | Individual
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Provider Name | KIM JAMES MASTERS MD
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Gender | Male
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Dates
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Enumeration Date | 06/26/2005
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Last Update Date | 10/27/2008
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Provider Practice Location Address
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Address Line | 200 ERMINE RD
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City | WEST COLUMBIA
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State | SC
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Zip | 29170-2024
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Country | US
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Telephone | 803-791-9918
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Fax | 803-926-5925
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Provider Business Mailing Address
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Address Line | PO BOX 3328
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City | TEGA CAY
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State | SC
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Zip | 29708-3328
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Country | US
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Telephone | 803-396-2130
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Fax | 803-396-2130
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 15205
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License Number State | SC
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