Provider Demographics
NPI:1285633313
Name:DEPRIEST, DAVID KIRK (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:KIRK
Last Name:DEPRIEST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:D
Other - Middle Name:KIRK
Other - Last Name:DEPRIEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 743294
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3294
Mailing Address - Country:US
Mailing Address - Phone:864-675-4815
Mailing Address - Fax:864-675-4780
Practice Address - Street 1:135 COMMONWEALTH DR., STE. 210
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4815
Practice Address - Country:US
Practice Address - Phone:864-675-4815
Practice Address - Fax:864-675-4780
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC792208600000X
OK4145208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200025290AMedicaid
SC007922Medicaid
SCSC85217628OtherMEDICARE PIN
OK200025290BOtherMEDICAID OSU AJ
OKP01319268OtherRAILROAD
OK298881YKW9Medicare PIN