Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 757 | SC |
NPI | 1366526030 |
---|---|
Provider Name | Dr. Kelly Stephenson Barth |
First Address | Hanahan, SC 29410-2408 |
Second Address | Charleston, SC 29425-5712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 15/07/2008 |