MEDICARE: KERSHAWHEALTH

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
1	207RG0100X	Gastroenterology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659686004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KERSHAWHEALTH

Provider Business Mailing Address
First Line	:	1303 MONUMENT SQ
Second Line	:
City	:	CAMDEN
State	:	SC
Zip	:	29020-3529
Country	:	US
Telephone Number	:	803-425-4337
Fax Number	:

Provider Business Practice Location Address
First Line	:	1303 MONUMENT SQ
Second Line	:
City	:	CAMDEN
State	:	SC
Zip	:	29020-3529
Country	:	US
Telephone Number	:	803-425-4337
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	MR. DONNIE J WEEKS
Credential	:
Telephone Number	:	803-713-6227

Provider Enumeration Date	:	08/10/2010
Last Update Date	:	08/10/2010

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Directions to “KERSHAWHEALTH ” Practice Location

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