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NPI Code Detail

MEDICARE: KAY W FELLOWS M.D.

MEDICARE: KAY W FELLOWS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianME68535FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
103246OTHERFLBCBS OF FL

General Provider Information

NPI Number : 1083698674
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAY W FELLOWS M.D.
Provider Business Mailing Address
First Line : PO BOX 30309
Second Line :
City : CHARLESTON
State : SC
Zip : 29417-0309
Country : US
Telephone Number : 843-554-9300
Fax Number : 843-566-8781
Provider Business Practice Location Address
First Line : 611 ZEAGLER DR
Second Line :
City : PALATKA
State : FL
Zip : 32177-3810
Country : US
Telephone Number : 386-328-5711
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2005
Last Update Date : 12/29/2011

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