Provider Demographics
NPI:1093163339
Name:ISOM, JULIA KILLINGSWORTH (DO)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:KILLINGSWORTH
Last Name:ISOM
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:1807 CROWNE COMMONS WAY
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-4931
Practice Address - Country:US
Practice Address - Phone:843-203-2280
Practice Address - Fax:843-203-2281
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2021-08-02
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Provider Licenses
StateLicense IDTaxonomies
SC39237207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC392374Medicaid