Provider Demographics
NPI:1265482913
Name:KOZACKI, KRISTA MARIE PRIGG (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:MARIE PRIGG
Last Name:KOZACKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTA
Other - Middle Name:MARIE
Other - Last Name:KOZACKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:360 N IRBY ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-2808
Mailing Address - Country:US
Mailing Address - Phone:843-667-9414
Mailing Address - Fax:843-667-1362
Practice Address - Street 1:3380 PINE NEEDLES RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-7908
Practice Address - Country:US
Practice Address - Phone:843-432-2952
Practice Address - Fax:843-799-1959
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16436207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCL13607Medicaid
SCL13607Medicaid
SCL13607Medicaid