Provider Demographics
NPI: | 1548588163 |
---|---|
Name: | DOCYK, KEVIN (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | KEVIN |
Middle Name: | |
Last Name: | DOCYK |
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: | PO BOX 743070 |
Mailing Address - Street 2: | |
Mailing Address - City: | ATLANTA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30374-3070 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 864-560-4304 |
Mailing Address - Fax: | 864-560-4413 |
Practice Address - Street 1: | 3611 PELHAM RD |
Practice Address - Street 2: | |
Practice Address - City: | GREENVILLE |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29615-5002 |
Practice Address - Country: | US |
Practice Address - Phone: | 864-530-3500 |
Practice Address - Fax: | 864-560-3525 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2010-05-06 |
Last Update Date: | 2023-08-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
SC | 37278 | 208D00000X |
SC | MD37278 | 207P00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | |
No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
SC | SC62846084 | Other | MEDICARE PIN |
SC | SC6284J577 | Other | MEDICARE PIN |
SC | SC62846067 | Other | MEDICARE PIN |
SC | 372787 | Medicaid |