Provider Demographics
NPI:1376562207
Name:RAINWATER, KELLY PRICE (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:PRICE
Last Name:RAINWATER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7162
Mailing Address - Fax:843-777-7102
Practice Address - Street 1:101 JOHNS STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2716
Practice Address - Country:US
Practice Address - Phone:843-777-7500
Practice Address - Fax:843-777-7533
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15682207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC156823Medicaid
SCF76682Medicare UPIN
SC160022056Medicare ID - Type UnspecifiedRAILROAD MEDICARE