Provider Demographics
NPI:1073611893
Name:MAYES, KATE BARRETT (MD)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:BARRETT
Last Name:MAYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 PARK AVE SE
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801
Mailing Address - Country:US
Mailing Address - Phone:803-641-1270
Mailing Address - Fax:803-641-1276
Practice Address - Street 1:223 PARK AVE SE
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801
Practice Address - Country:US
Practice Address - Phone:803-641-1270
Practice Address - Fax:803-641-1276
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL25307207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC253077Medicaid
SCP00423444OtherMEDICARE RAILROAD
SCAA15351562Medicare PIN
SCAA15351680Medicare PIN
SCP00423444OtherMEDICARE RAILROAD
SC253077Medicaid
SCAA15353365Medicare PIN