Provider Demographics
NPI:1518965193
Name:KIMBRELL, FRED MICHAEL (MD)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:MICHAEL
Last Name:KIMBRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W MEETING ST STE A
Mailing Address - Street 2:STE A
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-2380
Mailing Address - Country:US
Mailing Address - Phone:803-286-4666
Mailing Address - Fax:803-285-1585
Practice Address - Street 1:201 W MEETING ST
Practice Address - Street 2:STE A
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2380
Practice Address - Country:US
Practice Address - Phone:803-286-4666
Practice Address - Fax:803-283-1951
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10647207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC106478Medicaid
AK1353731OtherOTHER
AK1353731OtherOTHER
SCB918215986Medicare ID - Type Unspecified
SC106478Medicaid
AK1353731OtherOTHER