Provider Demographics
NPI:1295867059
Name:ASHLEY, KIMBERLY DAVES (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DAVES
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DENISE
Other - Last Name:DAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:370 SOUTH PIKE WEST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150
Mailing Address - Country:US
Mailing Address - Phone:803-774-7337
Mailing Address - Fax:803-774-4629
Practice Address - Street 1:370 SOUTH PIKE WEST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150
Practice Address - Country:US
Practice Address - Phone:803-774-7337
Practice Address - Fax:803-774-4629
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC279004Medicaid
SC279004Medicaid