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NPI Code Detail

MEDICARE: DR. KIM JAMES MASTERS MD

MEDICARE: DR. KIM JAMES MASTERS MD
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
12084P0804XChild & Adolescent Psychiatry Physician15205SC

General Provider Information

NPI Number : 1902802796
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KIM JAMES MASTERS MD
Provider Business Mailing Address
First Line : PO BOX 3328
Second Line :
City : TEGA CAY
State : SC
Zip : 29708-3328
Country : US
Telephone Number : 803-396-2130
Fax Number : 803-396-2130
Provider Business Practice Location Address
First Line : 200 ERMINE RD
Second Line :
City : WEST COLUMBIA
State : SC
Zip : 29170-2024
Country : US
Telephone Number : 803-791-9918
Fax Number : 803-926-5925
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2005
Last Update Date : 10/27/2008

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