Provider Demographics
NPI:1225028806
Name:DEVOLLD, KIMBERLY M (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:M
Last Name:DEVOLLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:S
Other - Last Name:ROHALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2754 MAYBANK HWY STE B
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-4809
Mailing Address - Country:US
Mailing Address - Phone:843-996-4908
Mailing Address - Fax:843-962-5450
Practice Address - Street 1:2754 MAYBANK HWY STE B
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-4809
Practice Address - Country:US
Practice Address - Phone:843-996-4908
Practice Address - Fax:843-962-5450
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86723173000000X
OH35094744208000000X
VA0101241911208000000X, 2080B0002X, 208D00000X
TN43204208000000X
SCMD40634208000000X, 2080B0002X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No173000000XOther Service ProvidersLegal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080B0002XAllopathic & Osteopathic PhysiciansPediatricsObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2029012Medicaid
FL266627800Medicaid
SC406340Medicaid
FL266627800Medicaid