Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 9813 | SC |
NPI | 1801361050 |
---|---|
Provider Name | Kimberly Holloway |
First Address | Greenville, SC 29601-2191 |
Second Address | Seneca, SC 29678-2546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2018 |
Last Update Date | 03/10/2018 |