Provider Demographics
NPI:1528058641
Name:KERSHAW HEALTH
Entity type:Organization
Organization Name:KERSHAW HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-713-6227
Mailing Address - Street 1:1315 ROBERTS ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-3737
Mailing Address - Country:US
Mailing Address - Phone:803-432-4311
Mailing Address - Fax:
Practice Address - Street 1:40 PINNACLE PARKWAY
Practice Address - Street 2:BUILDING 100 SUITE 208
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-8999
Practice Address - Country:US
Practice Address - Phone:803-424-5165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2222Medicaid
SCGP2222Medicaid