Provider Demographics
NPI:1447209374
Name:HOLLOWAY, KIMBERLY SUE (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUE
Last Name:HOLLOWAY
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 1:330C PELHAM RD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3111
Mailing Address - Country:US
Mailing Address - Phone:864-720-1299
Mailing Address - Fax:864-720-1300
Practice Address - Street 1:330 PELHAM RD STE 101C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3111
Practice Address - Country:US
Practice Address - Phone:864-720-1299
Practice Address - Fax:864-720-1300
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20987207VG0400X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00352725OtherRR MEDICARE
SC209875Medicaid
SCP00352725OtherRR MEDICARE
SC209875Medicaid
SCP00352725OtherRR MEDICARE
SCH384663640Medicare PIN
SC576007863177OtherBCBS OF SC
SCH384667951Medicare PIN