Provider Demographics
NPI:1699706424
Name:KERRISON, HORRY HERIOT (MD)
Entity type:Individual
Prefix:MR
First Name:HORRY
Middle Name:HERIOT
Last Name:KERRISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401
Mailing Address - Country:US
Mailing Address - Phone:843-577-6506
Mailing Address - Fax:843-723-9835
Practice Address - Street 1:31 SMITH ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401
Practice Address - Country:US
Practice Address - Phone:843-577-6506
Practice Address - Fax:843-723-9835
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4315207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC043152Medicaid
SCD99146Medicare UPIN
SCD99146Medicare ID - Type Unspecified