Provider Demographics
NPI:1235659640
Name:GARVIN, KELLY REDLINGER (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:REDLINGER
Last Name:GARVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARGARET
Other - Last Name:REDLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:803-791-2000
Mailing Address - Fax:229-353-6060
Practice Address - Street 1:122 POWELL DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9203
Practice Address - Country:US
Practice Address - Phone:803-957-8400
Practice Address - Fax:803-957-1939
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC90534207Q00000X
GA86312207Q00000X
SCLL51166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine