Provider Demographics
NPI:1184842239
Name:SKINNER, ADA KATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ADA
Middle Name:KATHLEEN
Last Name:SKINNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ADA
Other - Middle Name:KATHLEEN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3545 QUEEN CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29153-8115
Mailing Address - Country:US
Mailing Address - Phone:803-469-0978
Mailing Address - Fax:803-469-0976
Practice Address - Street 1:1409 DEVINE ST
Practice Address - Street 2:UNIVERSITY OF SOUTH CAROLINA
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29208-0001
Practice Address - Country:US
Practice Address - Phone:803-777-3174
Practice Address - Fax:803-777-0126
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29150390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program