Provider Demographics
NPI:1407042476
Name:ATKINSON, KATHERINE JOY (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JOY
Last Name:ATKINSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2899
Mailing Address - Country:US
Mailing Address - Phone:864-522-8611
Mailing Address - Fax:
Practice Address - Street 1:9 RICHLAND MEDICAL PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6869
Practice Address - Country:US
Practice Address - Phone:803-434-6155
Practice Address - Fax:803-434-3855
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL 30232208000000X
SC30232208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC302327Medicaid